Treating post-trauma nightmares and posttraumatic stress disorder in an individual with psychosis

Post-trauma nightmares often persist, even following intervention for posttraumatic stress disorder (PTSD) (Davis, DeArellano, Falsetti, & Resnick, 2003;Scurfield, Kenderdine, & Pollard, 1990).  Research finds that directly targeting post-trauma nightmares is effective in reducing their frequency and severity, as well as improving related symptoms (Augedal, Hansen, Kronhaug, Harvey, & Pallesen, 2013; Casement & Swanson, 2012; Ho, Chan, & Tang, 2016; Krippner & Taitz, 2017; Rousseau & Belleville, 2018).  Most efforts exploring the efficacy of interventions for post-trauma nightmares have not been evaluated in individuals with psychosis.  However, recent research suggests that individuals with psychosis experience frequent nightmares and comorbidity with traumatic stress disorders (Sheaves, Onwumere, Keen, Stahl, & Kuipers, 2015).  The current study evaluated the efficacy of a combination of two treatments, Exposure, Relaxation, and Rescripting Therapy (Davis, 2009) and Cognitive Processing Therapy (Resick, Monson, & Chard, 2017), for an individual with visual and tactile hallucinations, nightmares, and PTSD. Results indicated that the participant tolerated all treatment aspects, including written exposure to the content of the post-trauma nightmares.  Further, the combined treatment resulted in improvement in trauma-related nightmare frequency and severity, PTSD symptoms, negative posttraumatic cognitions, depressive symptoms, and sleep quality and quantity.  Findings suggested that individuals with frequent nightmares, PTSD, and psychosis may benefit from direct treatments targeting these conditions.