Effectiveness of a group rescripting intervention for trauma-related nightmares: A small-N design

Aims: Following a traumatic experience, nightmares can maintain psychological distress. Interventions that include the treatment of trauma-related nightmares contribute to increasing psychological and physical well-being. This study examined the efficacy of treating trauma-related nightmares independently, using a cognitive-behavioural rescripting intervention. The influence of metacognitive beliefs about the power and meaning of nightmares was also addressed. Method: The study employed a mixed quantitative and qualitative design reporting on ten participants suffering with chronic trauma-related nightmares. Participants completed a six-hour group treatment of Exposure, Relaxation and Rescripting Therapy (ERRT: Davis & Wright, 2005). Treatment effects were examined using sleep diaries, measures of anxiety and depression and the Nightmare Belief Questionnaire. Qualitative interviews were held with participants at follow-up and thematic analysis was used to analyse the transcripts. Results: Medium to large treatment effect sizes were noted for nightmare frequency, distress, sleep efficiencies, cognitive beliefs, depression and anxiety. Qualitative interviews identified six themes relating to the participant experience. Overall, participants found the intervention successful to help them eliminate or reduce their trauma-related nightmares citing important factors of new learning, gaining a sense of mastery and control and the engagement with others in a group treatment. Conclusion: ERRT appears to be an effective intervention for treating the frequency and distress of trauma-related nightmares whilst improving sleep efficiency and mood. It is proposed that establishing a sense of mastery is among the predominant mechanisms of change and improvements in metacognitive beliefs around the power and meaning of nightmares are a contributory factor to sustainability