Remission of PTSD and comorbid OCD symptoms through psychotherapy for nightmares: A case report

Introduction

Research on nightmares and psychiatric disorders has predominantly focused on post-traumatic stress disorder (PTSD). This case report aims to explore the impact of treating post-traumatic nightmares on obsessive compulsive disorder (OCD) symptoms that emerged following a traumatic experience.

Case

A woman in her mid-twenties with PTSD, post-traumatic nightmares and OCD symptoms was treated with exposure, relaxation and rescripting therapy (ERRT). This therapy consists of altering one’s nightmares and repeatedly imagining the new dream during wakefulness, supplemented with sleep hygiene, time-in-bed restriction, stimulus control, exposure to the nightmares and relaxation techniques.

Results

The results indicate that utilizing ERRT for Laura's post-traumatic nightmares has resulted in the remission of PTSD, comorbid OCD symptoms, nightmares, insomnia symptoms and stress, along with a significant reduction in anxiety.

Conclusion

This case study illustrates that treating post-traumatic nightmares through ERRT in an individual with comorbid post-traumatic OCD symptoms is feasible and can positively impact both nightmares and OCD symptoms. The underlying mechanism is hypothesized to be that improving sleep enhances both fear extinction learning and emotion regulation—two processes known to be impaired in OCD. In this particular case, the reduction in evening hyperarousal and anxiety, resulting from the time-in-bed restriction, likely also contributed to a decrease in obsessive thoughts.