Status of Imagery Rehearsal Therapy and Other Interventions for Nightmare Treatment in PTSD.

Purpose of review: We review the recent published literature on nightmare-focused interventions, including imagery rehearsal therapy, for trauma-exposed adult populations.

Recent findings: Imagery rehearsal therapy (IRT) and prazosin remain the most supported treatments, though results vary across studies. New consensus guidelines have led to Cognitive Behavioral Therapy for Nightmares (CBT-N), which integrates rescripting, exposure, and sleep strategies. Digital self-management, brief coaching-support, and tools like lucid dreaming or targeted memory reactivation show promise. Integrated and sequenced approaches with PTSD or insomnia treatments may improve outcomes, though evidence remains mixed. While trauma-focused treatments reduce PTSD symptoms, nightmares may persist without targeted care. Standardized CBT-based approaches, consistent outcome measurement, and studies on mechanisms and sequencing are needed to optimize and expand access to nightmare treatment.