When the mind reprocesses the night: A clinical case study on eye movement desensitization and reprocessing therapy for idiopathic nightmare disorder

Abstract

Introduction: Nightmare Disorder (ND) is a prevalent sleep disorder linked to nocturnal and daytime impairments. Image Rehearsal Therapy (IRT) shows moderate effects, and evidence for other psychological interventions, including eye movement desensitization and reprocessing (EMDR), remains scarce in adults with idiopathic ND (IND).

Methods: This case study explored EMDR therapy's potential for treating IND. Nightmare symptoms, nightmare-related distress, and sleep quality were assessed pre- (T1) and post-intervention (T2).

Results: Score changes were clinically meaningful and reliable within a 95% confidence interval, with T2 scores falling within the normative range.

Conclusions: Specialized nightmare treatment reduces functional impact and chronicity; further investigation of EMDR therapy could improve intervention.

Keywords

EMDR / idiopathic / nightmare disorder / nightmares

References

[1] Garriques VR, Dhruve DM, Nadorff MR. Nightmare disorder. Sleep Med Clin. 2024;19(1):111-119. https://doi.org/10.1016/j.jsmc.2023.10.011

[2] Ouchene R, El Habchi N, Demina A, Petit B, Trojak B. The effectiveness of lucid dreaming therapy in patients with nightmares: a systematic review. L’Encéphale. 2023;49(5):525-531. https://doi.org/10.1016/j.encep.2023.01.008

[3] Rufino KA, Patriquin MA, Worley CB, Nadorff MR. Prevalence of clinically relevant nightmares and their differences by sex and diagnosis in psychiatric inpatients. Sleep Med. 2026;137:106900. https://doi.org/10.1016/j.sleep.2025.106900

[4] Van Der Wijk G, Blaskovich B, Farahzadi Y, Simor P. Unaltered EEG spectral power and functional connectivity in REM microstates in frequent nightmare recallers: are nightmares really a REM parasomnia? Sleep Med. 2020;75:192-200. https://doi.org/10.1016/j.sleep.2020.07.014

[5] Sayk C, Koch N, Stierand J, et al. Imagery rehearsal therapy for the treatment of nightmares in individuals with borderline personality disorder - a pilot study. J Psychiatr Res. 2025;182:34-41. https://doi.org/10.1016/j.jpsychires.2024.12.044

[6] Sheaves B, Rek S, Freeman D. Nightmares and psychiatric symptoms: a systematic review of longitudinal, experimental, and clinical trial studies. Clin Psychol Rev. 2023;100:102241. https://doi.org/10.1016/j.cpr.2022.102241

[7] Sun K, Wang X, Zhou G, et al. A systematic review on investigating major depressive disorder and bipolar disorder using MRI and genetic data from 2018 to 2024. Brain-X. 2024;2(3):e70000. https://doi.org/10.1002/brx2.70000

[8] Zhukovsky P, Wainberg M, Milic M, et al. Multiscale neural signatures of major depressive, anxiety, and stress-related disorders. Proc Natl Acad Sci USA. 2022;119(23):e2204433119. https://doi.org/10.1073/pnas.2204433119

[9] Aurora RN, Zak RS, Auerbach SH, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389-401. https://doi.org/10.5664/jcsm.27883

[10] Yücel DE, Van Emmerik AAP, Souama C, Lancee J. Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: a meta-analysis of randomized controlled trials. Sleep Med Rev. 2020;50:101248. https://doi.org/10.1016/j.smrv.2019.101248

[11] Morgenthaler TI, Auerbach S, Casey KR, et al. Position paper for the treatment of nightmare disorder in adults: an American academy of sleep medicine position paper. J Clin Sleep Med. 2018;14(6):1041-1055. https://doi.org/10.5664/jcsm.7178

[12] Wagner AM, Richards A, Chiros C, et al. A retrospective pilot study of imagery rehearsal therapy enhanced with narrative therapy principles for the treatment of nightmares in US military veterans. Sleep Sci. 2023;16(4):e439-e445. https://doi.org/10.1055/s-0043-1776796

[13] Gieselmann A, Ait Aoudia M, Carr M, et al. Aetiology and treatment of nightmare disorder: state of the art and future perspectives. J Sleep Res. 2019;28(4):e12820. https://doi.org/10.1111/jsr.12820

[14] Augedal AW, Hansen KS, Kronhaug CR, Harvey AG, Pallesen S. Randomized controlled trials of psychological and pharmacological treatments for nightmares: a meta-analysis. Sleep Med Rev. 2013;17(2):143-152. https://doi.org/10.1016/j.smrv.2012.06.001

[15] Karadag M, Gokcen C, Sarp AS. EMDR therapy in children and adolescents who have post-traumatic stress disorder: a six-week follow-up study. Int J Psychiatr Clin Pract. 2020;24(1):77-82. https://doi.org/10.1080/13651501.2019.1682171

[16] Freiha T. The image director technique for dreams. In: Luber M, ed. Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols: Basics and Special Situations. Springer Publishing Company; 2009:111-118. https://doi.org/10.1891/9780826122384.0017

[17] Almeida F, Pires L, Gomes AA. Investigating the dimensionality of the Portuguese nightmare disorder index (NDI-P): exploratory and confirmatory factor analysis. In: Pereira SP, Monteiro JL, Moreira APF, eds. Book of abstracts of the 15th National Symposium on Research in Psychology. Portuguese Association of Psychology; 2025:99-100. https://appsicologia.org/Files_xSnip/SNIP_2025_Livro_de_Resumos.pdf

[18] Lopes A. Os pesadelos e a sua relação com o trauma, a psicopatologia e a personalidade: Um estudo epidemiológico e de adaptação do Nightmare Distress Questionnaire numa amostra da população portuguesa [Master’s thesis]. University of Coimbra; 2019. Digital Repository. https://www.eg.uc.pt/handle/10316/94787

[19] Miller-Mendes M, Gomes AA, Ruivo Marques D, Clemente V, Azevedo MHP. BaSIQS - basic scale on insomnia complaints and quality of sleep: reliability, norms, validity, and accuracy studies, based on clinical and community samples. Chronobiol Int. 2019;36(5):644-656. https://doi.org/10.1080/07420528.2019.1578970

[20] Helmich MA. The duration-adjusted reliable change index: defining clinically relevant symptom changes of varying durations. Assessment. 2024;31(7):1493-1507. https://doi.org/10.1177/10731911231221808

[21] Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12-19. https://doi.org/10.1037/0022-006x.59.1.12

[22] Nuzzo RL. An introduction to Bayesian data analysis for correlations. PM&R. 2017;9(12):1278-1282. https://doi.org/10.1016/j.pmrj.2017.11.003

[23] Devilly GJ. ClinTools software for windows: reliable change generator (version 3.5). [Computer software]. Psytek Ltd; 2005. https://www.clintools.com

[24] Morley S, Dowzer CN. Manual for the Leeds Reliable Change Indicator: Simple Excel™ Applications for the Analysis of Individual Patient and Group Data [Manual]. University of Leeds; 2014.

[25] Woo M. Eye movement desensitization and reprocessing treatment of nightmares: a case report. J EMDR Pract Res. 2014;8(3):129-134. https://doi.org/10.1891/1933-3196.8.3.129

[26] Gieselmann A, Elberich N, Mathes J, Pietrowsky R. Nightmare distress revisited: cognitive appraisal of nightmares according to Lazarus’ transactional model of stress. J Behav Ther Exp Psychiatr. 2020;68:101517. https://doi.org/10.1016/j.jbtep.2019.101517

[27] Paul F, Schredl M, Alpers GW. Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study. Borderline personality Disord Emot dysregulation. 2015;2(1):3. https://doi.org/10.1186/s40479-014-0023-4

[28] Rousseau PF, Vallat R, Coste O, et al. Sleep parameters improvement in PTSD soldiers after symptoms remission. Sci Rep. 2021;11(1):8873. https://doi.org/10.1038/s41598-021-88337-x

[29] Wu X, Zhang K, Kuang N, et al. Developing brain asymmetry shapes cognitive and psychiatric outcomes in adolescence. Nat Commun. 2025;16(1):4480. https://doi.org/10.1038/s41467-025-59110-9

[30] Martínez MP, Miró E, Arriaza R. Evaluation of the distress and effects caused by nightmares: a study of the psychometric properties of the nightmare distress questionnaire and the nightmare effects survey. Sleep Hypn. 2005;7(1):29-41.

RIGHTS & PERMISSIONS

2026 The Author(s). Sleep Research published by John Wiley & Sons Australia, Ltd on behalf of Chinese Sleep Research Society.