Imagery Rehearsal Therapy: The Nightmare Rescripting Term

Imagery rehearsal therapy (IRT) is a technique for chronic nightmares: you write down a recurring bad dream, rewrite its ending or storyline into something non-distressing, then mentally rehearse the new version for a few minutes each day while fully awake. Sleep-medicine guidelines rank it as the best-evidenced nightmare treatment available, ahead of both EMDR and medication.

Who developed imagery rehearsal therapy?

Barry Krakow, MD, and Joseph Neidhardt, MD, formalized the technique in their 1992 book, Conquering Bad Dreams and Nightmares. It turned earlier nightmare-rehearsal research into a structured, teachable method. Krakow went on to lead a landmark randomized controlled trial, published in JAMA in 2001.

Is it safe to try on your own?

Generally, yes, more so than many nightmare techniques, since nothing gets relived, only rewritten while you’re awake. Still, go carefully if the nightmare touches a real trauma.

Build a calm-place or grounding practice first. Then start with a smaller, less intense recurring dream rather than your worst one, and keep early rehearsal sessions short. If distress rises above a 7 out of 10 and won’t settle, stop and ground yourself. Treat that as a cue to work with a professional trained in imagery rehearsal therapy or EMDR, rather than continuing alone.

How does imagery rehearsal therapy work?

The method has three steps. First, pick one recurring nightmare and write it down in detail. Then rewrite the storyline into a new version that feels neutral or safe; the change doesn’t need to make logical sense. Finally, spend a few minutes picturing the new version while fully awake, away from bedtime.

In Krakow’s 2001 trial, women who were sexual assault survivors living with PTSD-related chronic nightmares practiced this method in a short series of structured group sessions.

Is imagery rehearsal therapy backed by research?

Yes, more solidly than most nightmare treatments. In that 2001 JAMA trial, the treatment group’s nightmare frequency and PTSD severity had dropped three months later, and sleep quality had improved, with moderate-to-large effect sizes against a wait-list control.

A 2012 meta-analysis in Clinical Psychology Review pooled 13 studies. It found large, lasting effects on nightmare frequency, sleep quality, and PTSD severity, holding up 6 to 12 months later.

A 2018 American Academy of Sleep Medicine position paper gives imagery rehearsal therapy its strongest recommendation for treating nightmare disorder, trauma-linked or not. That’s a tier EMDR doesn’t reach for nightmares specifically.

How does imagery rehearsal therapy differ from EMDR?

Both target trauma-linked nightmares, but the methods have nothing in common. Imagery rehearsal therapy is entirely cognitive: you consciously rewrite a dream’s story and rehearse it while awake, with no bilateral stimulation involved. EMDR instead pairs alternating eye movements, taps, or tones with a briefly held image, inside a structured, therapist-led protocol. See our nightmares guide for that fuller comparison.

A nightmare’s aftermath is a separate problem from its storyline. If your body stays keyed up the next day, EmEase, a self-guided EMDR app, offers guided bilateral stimulation at app.emease.com as a way to settle afterward, alongside imagery rehearsal therapy rather than in place of it.