Imagery Control Therapy and Lucid Dreaming for REM-Related Symptoms in Narcolepsy

NCT07609537 | Completed

• 2 other identifiers: IMCS019864647898646478
• Study Type: interventional
• Target: 98
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial evaluated the efficacy of a cognitive behavioral intervention based on lucid dreaming training and imagery control therapy for reducing REM-related symptoms in patients with narcolepsy type 1. Specifically, the study examined the impact of the intervention on hypnagogic hallucinations and sleep paralysis, which are common and distressing symptoms associated with REM sleep intrusions in narcolepsy. Ninety-eight adults with confirmed narcolepsy type 1 were randomly assigned to either an experimental intervention group or a control group receiving standard pharmacological treatment, structured clinical follow-up, and sleep hygiene psychoeducation. The intervention consisted of six weekly 90-minute telehealth sessions integrating psychoeducation, dream awareness training, lucid dreaming induction techniques, imagery rehearsal therapy (IRT), metacognitive strategies, emotional regulation, and relapse prevention. Primary outcomes included changes in the frequency and distress associated with hypnagogic hallucinations and sleep paralysis. Secondary outcomes included subjective sleep quality, metacognitive dream-related variables, and quality of life. Participants were assessed at baseline, post-treatment, and at 6- and 12-month follow-up evaluations. The study aimed to determine whether behavioral interventions targeting dream awareness, emotional regulation, and metacognitive control could complement pharmacological treatment and improve REM-related symptoms and sleep-related quality of life in narcolepsy.

Conditions

Narcolepsy Type 1; Hypnagogic Hallucinations; Sleep Paralysis; REM Sleep Intrusion Symptoms; Central Disorders of Hypersomnolence

Keywords

Narcolepsy; REM sleep; Lucid dreaming; Imagery Control Therapy; Cognitive Behavioral Therapy; Hypnagogic hallucinations; Sleep paralysis; REM sleep intrusion; Excessive daytime sleepiness; Narcolepsy Type 1; Central disorders of hypersomnolence; Sleep disorder therapy

Outcome Measures

Primary Outcomes (1)

• Change in Frequency and Distress of REM-Related Symptoms (Hypnagogic Hallucinations and Sleep Paralysis) measured by Narcolepsy Severity Scale (NSS)

  The primary outcome is the change in frequency and subjective distress of hypnagogic hallucinations and sleep paralysis in patients with narcolepsy type 1. Symptoms are assessed using the Narcolepsy Severity Scale (NSS), a validated self-report instrument where each item is scored 0-5; higher scores indicate greater severity. Structured clinical evaluations supplement the NSS to evaluate reductions in REM-related intrusion symptoms and associated emotional burden following the behavioral intervention.

  Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.

Secondary Outcomes (1)

• Change in Subjective Sleep Quality Assessed by the Pittsburgh Sleep Quality Index (PSQI)

  Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.

Other Outcomes (2)

• Change in Dream-Related Metacognitive Variables Assessed by the Lucidity and Consciousness in Dreams Scale (LuCiD)

  Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up.

• Change in Health-Related Quality of Life Assessed by the Short Form 36 Health Survey (SF-36)

  Baseline, post-treatment (6 weeks), 6-month follow-up, and 12-month follow-up

Study Arms (2)

Experimental: CBT-NAR With Lucid Dreaming and Imagery Control Therapy

EXPERIMENTAL

Participants received six weekly 90-minute sessions of cognitive behavioral therapy for narcolepsy (CBT-NAR) integrating lucid dreaming training and imagery control therapy, delivered via synchronous telehealth by trained clinical psychologists specialized in behavioral sleep medicine. The intervention included psychoeducation on narcolepsy and REM-related symptoms, dream diary training, lucid dreaming induction techniques, metacognitive strategies, imagery rehearsal therapy (IRT), emotional regulation techniques, relapse prevention, and sleep hygiene education focused on sleep-wake regularity and scheduled nap regulation. Participants continued stable pharmacological treatment throughout the study.

Behavioral: Cognitive Behavioral Therapy for Narcolepsy (CBT-NAR) With Lucid Dreaming and Imagery Control Therapy

Active Comparator: Standard Treatment and Sleep Hygiene Education

ACTIVE COMPARATOR

Participants continued stable standard pharmacological treatment for narcolepsy combined with structured clinical follow-up and psychoeducation in sleep hygiene. Sleep hygiene education included recommendations regarding sleep-wake schedule regularity, scheduled naps, healthy sleep habits, and general education about narcolepsy. No lucid dreaming training, imagery control techniques, or metacognitive dream interventions were administered to this group.

Behavioral: Sleep Hygiene Education and Structured Clinical Follow-up

Interventions

Cognitive Behavioral Therapy for Narcolepsy (CBT-NAR) With Lucid Dreaming and Imagery Control Therapy BEHAVIORAL

A structured six-session behavioral intervention designed for patients with narcolepsy type 1 experiencing REM-related symptoms such as hypnagogic hallucinations and sleep paralysis. The intervention integrated cognitive behavioral therapy for narcolepsy (CBT-NAR), lucid dreaming training, and imagery control techniques. Components included psychoeducation about narcolepsy and REM sleep physiology, dream diary monitoring, dream awareness training, lucid dreaming induction and maintenance strategies, reality testing, metacognitive techniques, imagery rehearsal therapy (IRT), emotional regulation strategies, modification of distressing dream content, relapse prevention, and sleep hygiene education focused on sleep-wake regularity and scheduled nap regulation. Sessions were delivered weekly via synchronous telehealth by trained clinical psychologists specialized in behavioral sleep medicine while participants continued stable pharmacological treatment.

Experimental: CBT-NAR With Lucid Dreaming and Imagery Control Therapy

Sleep Hygiene Education and Structured Clinical Follow-up BEHAVIORAL

Participants received structured clinical follow-up and behavioral sleep hygiene psychoeducation while continuing stable pharmacological treatment for narcolepsy. The intervention included education regarding sleep-wake schedule regularity, scheduled naps, healthy sleep habits, management of daytime sleepiness, and general education about narcolepsy and REM-related symptoms. Sessions were delivered remotely through synchronous telehealth contacts with a frequency comparable to routine clinical follow-up. No lucid dreaming training, imagery control techniques, imagery rehearsal therapy, or metacognitive dream interventions were provided in this comparator arm.

Active Comparator: Standard Treatment and Sleep Hygiene Education

Eligibility Criteria

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

You may qualify if:

• Adults aged ≥18 years diagnosed with Narcolepsy Type 1, confirmed by clinical evaluation and polysomnography.
• Experiencing clinically significant hypnagogic hallucinations and/or sleep paralysis.
• Stable pharmacological treatment for narcolepsy, such as modafinil and/or methylphenidate.
• Able and willing to provide informed consent electronically.
• Available to participate in six weekly virtual intervention sessions.
• Willing to adhere to structured medical follow-up, including sleep hygiene education, nap guidance, sleep habit stabilization, and participation in sleep schedule programs.

You may not qualify if:

• Presence of severe psychiatric disorders or dissociative disorders. Active use of psychoactive substances during the study period.
• Participation in other interventions targeting lucid dreaming or imagery rehearsal during the trial.
• Any medical or cognitive condition that, in the investigator's judgment, would interfere with participation or adherence to the intervention.

Sponsors & Collaborators

• Institute of Behavioral Sleep Medicine, Colombia: lead

Study Sites (1)

Bahavioral Sleep Medicine Institute

Medellín, Antioquia, 050021, Colombia

Location

MeSH Terms

Conditions

Hallucinations; Sleep Paralysis; Narcolepsy; Disorders of Excessive Somnolence

Interventions

Cognitive Behavioral Therapy

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; REM Sleep Parasomnias; Parasomnias; Sleep Wake Disorders; Mental Disorders; Sleep Disorders, Intrinsic; Dyssomnias

Intervention Hierarchy (Ancestors)

Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• IVAN FRANCISCO IF ALVAREZ OROZCO, MD, MS, PhD (c)

  Neumocenter, Valledupar, Colombia

  STUDY CHAIR

• Ulises U Jiménez Correa, MS, PhD

  Seep Disorder Clínic, Research Division, Faculty of Medicine, National Autonomous University of Mexico

  STUDY CHAIR

• HERNAN ANDRES HA MARIN AGUDELO, MS, PhD, Postdoctoral Research

  BEHAVIORAL SLEEP MEDICINE INSTITUTE

  PRINCIPAL INVESTIGATOR

• JENNY J JURADO HERNANDEZ, MD, MS

  HOSPITAL MILITAR CENTRAL BOGOTÁ

  STUDY CHAIR

• Liliana L Estrada Chaverri, MD, MS

  Sleep Med Costa Rica / Sleep Disorders Medical Center

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: (Participants and care providers were not blinded because of the behavioral nature of the intervention, but outcome evaluators and the statistical analyst remained blinded to group allocation.)
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants with narcolepsy type 1 were randomly assigned in a 1:1 ratio to one of two parallel groups. The experimental group received six weekly 90-minute sessions of cognitive behavioral therapy for narcolepsy (CBT-NAR) integrating lucid dreaming training and imagery control therapy in addition to stable pharmacological treatment. The control group continued standard pharmacological treatment combined with structured clinical follow-up and sleep hygiene psychoeducation focused on sleep-wake regulation, scheduled naps, and healthy sleep habits. Outcomes were assessed longitudinally at baseline, post-treatment, 6 months, and 12 months. The study used a parallel-group randomized controlled design to compare changes in REM-related symptoms, sleep quality, metacognitive dream variables, and quality of life between groups.

Study Record Dates

• First Submitted: May 17, 2026
• First Posted: May 27, 2026
• Study Start: March 1, 2024
• Primary Completion: June 1, 2025
• Study Completion: June 15, 2025
• Last Updated: May 28, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

CO (1)