| Technique* | Principles | Length of treatment |
| First-line psychotherapeutic interventions for nightmare disorder |
| Image rehearsal therapy (IRT)¶ | - Modification of CBT, using all principles of cognitive and behavioral intervention in association with imagery
- Involves altering/rescripting the content from negative to positive/neutral theme and rehearsing this new narrative to manage nightmares
| Specific 6+ sessions involving worksheets and homework |
| Cognitive behavioral therapy (CBT) | - Short-term, goal-oriented psychotherapy
- Psychological, cognitive, and behavioral intervention tailored to correct distortions and modify behavior to treat nightmares
- Focus on dysfunctional thoughts, irrational beliefs, and associated maladaptive behaviors
| 8 to 12 sessions involving focused treatments on negative cognitions and maladaptive behavior |
| Cognitive behavioral therapy for insomnia (CBT-I) | - Short-term CBT intervention
- Specific intervention targeting sleep and insomnia
| 6 to 12 sessions involving focused treatments on negative cognitions and maladaptive behavior |
| Additional psychotherapeutic interventions for nightmare disorder |
| Exposure, relaxation, and rescripting therapy (ERRT) | - Specialized intervention using variation of CBT with exposure to disturbing nightmare content, progressive muscle relaxation, and rescripting
| 3-week treatment or more |
| Eye movement desensitization and reprocessing (EMDR) | - Combination of integrated therapies targeting anxiety as well as physiological, behavioral, and cognitive dysfunction
- Interventions utilize adaptive information processing with recalling distressing images while generating one type of bilateral sensory input, such as side-to-side eye movements or hand tapping
| Variable (tailored) |
| Progressive deep muscle relaxation (PDMR) | - Involves tensing and then releasing the muscles one group of muscles at a time to bring a feeling of physical relaxation and reduction in anxiety, stress, and nightmares
| Variable (short- or long-term) |
| Self-exposure therapy | - Variant of CBT using graded exposure
- Involves making a hierarchical list of severity of anxiety-provoking events/dreams and moving through the list in a graded manner until the anxiety and stress is managed in the lowest category
- Exposure is done on a daily basis and documented in a journal
| Variable (long-term) |
| Lucid dreaming | - Uses CBT and cognitive restructuring
- A variant of IRT that allows one to alter the nightmare story line during the experience of the nightmare itself by using the technique of lucid dreaming to alter the narrative during sleep while experiencing the nightmare
| Variable (long-term) |
| Hypnosis | - Creates a state of deep physical and emotional relaxation that opens the mind to suggestions that can be used to change thoughts and behaviors to manage nightmares
| Variable (long-term) |
| Systematic desensitization or graduated exposure therapy | - With gradual exposure to fearful stimuli, the patient is trained to cope with and manage the stressors before actually being exposed to the stressful situation
| Variable (long-term) |
| The testimony method | - A variant of trauma exposure technique with documenting and expressing the trauma with the help of a therapist
| Variable (long-term) |
| Individual psychotherapy | - Specialized treatment with utilization of psychotherapeutic techniques using therapeutic alliance, psychoanalysis, and interpersonal therapy, among others
| Variable (long-term) |
