| Session 1 | Session 1 focuses on creating a comfortable psychotherapeutic environment, and the therapist gets to know the client's particular difficulties with sleep and nightmares. The therapist presents an overview of the six-session treatment and provides psychoeducation about PTSD, sleep, and nightmares. In addition, the client will be taught de-arousal/grounding strategies to use when awakened by a nightmare. |
| Session 2 | Session 2 is focused on helping the client to choose and write out the target nightmare. Because this task is often associated with an increase in anxiety, progressive muscle relaxation is also taught in this session. |
| Session 3 | Session 3 covers psychoeducation about sleep hygiene and sleep habits, and encourages problem solving about possible changes in the client's sleep habits. The therapist also provides the client with specific examples and suggestions for changing the nightmare to make the dream less distressing and more like a normal dream. |
| Session 4 | Session 4 introduces stimulus control procedures. Stimulus control seeks to reestablish a conditioned association between the bed/bedroom and sleep by reducing time spent tossing and turning in bed. Next, the therapist continues to brainstorm with the client about ways of "rescripting" the target nightmare and then helps him/her to write out the new dream script. |
| Session 5 | Session 5 reviews previously discussed sleep management strategies and obstacles to change, and discusses the effects of daily stressors and the put the day to rest exercise. The therapist reviews the client's experience with rehearsing the rescripted dream during the previous week and suggests ways of removing obstacles to rehearsal and, possibly, revisions to the changed script. |
| Session 6 | Session 6, the final session, reviews progress made in treatment. If needed, the new script is further "fine-tuned." Any changes in sleep and nightmares experienced by the client during the treatment are reviewed and summarized and the client is encouraged to examine likely stressors and obstacles to consistent practice in the months ahead. |
