Imagery Rehearsal Therapy Analysis

Through these studies, we have seen that IRT appears to be at least as effective as other treatment modalities and can be a viable option for clinicians helping clients reduce trauma-related nightmares (Casement & Swanson, 2012; Krakow et al., 2001; Lu et al., 2009; Seda et al., 2015). Imagery Rehearsal Therapy is a Cognitive Behavioral Therapy intervention which several of the researchers sought to compare to other treatment modalities. Casement and Swanson (2009) compared the effects of IRT alone against a combination of CBTI and IRT. Unsurprisingly, the combination of CBTI and IRT was found to be more effective than IRT alone. Since CBTI and IRT combined would have the ability to address a wider variety of sleep symptoms, the combination
of these modalities would have greater opportunity to address a wider variety of symptoms which could occur as a result of PTSD.
CBTI was not the only modality to be examined in the reviewed studies. Seda et al. (2015) compared a variety of treatment combinations for the following modalities: psychopharmacology with Prazosin, CBTI, and IRT. Similar to the results from 2009 meta-analysis, Seda et al. (2015) found that a combination of CBTI and IRT showed greater effectiveness than IRT alone. As noted earlier, amongst other modality combinations, IRT, Prazosin, and CBTI showed equally effective.
Other modalities which can help with trauma-related nightmares include: lucid dreaming, a variant of IRT; exposure, relaxation and rescripting therapy (ERRT); sleep dynamic therapy; self-exposure therapy; systematic desensitization; progressive deep muscle relaxation training; hypnosis; eye movement desensitization and reprocessing (EMDR); and the testimony method (Aurora et al., 2010). Each of these modalities is graded for level of recommendation by Aurora et al. (2010) based upon the amount of high quality evidence and clinical judgment of the authors.
From the list, IRT is the only non-pharmacological treatment recommended for the highest level, level A, given the amount of clinical evidence supporting the therapy (Aurora et al., 2010). Several explanations could exist for the reason why IRT is the only Level A recommended treatment. Lack of evidence and lower treatment recommendation level could be due to several factors. Lack of funding could be one possible reason or lack of evidence for other modalities. Limited studies could also be due to the length of time the modality has been available; lucid dreaming is a newer treatment method than IRT which means it has not had the time to be researched as IRT. Despite the reasons which could explain lack of evidence for other non-pharmacological treatment methods, IRT could be a good option for clinicians who are seeking to practice from an evidence-based perspective.
Although IRT may be a good option for a clinician with an evidence-based perspective, it is imperative that clinicians consider whether IRT has been tested with various populations.
Unfortunately, the reviewed research shows massive gaps in testing IRT with varying populations. In all the studies examined, IRT was researched with predominantly White populations; other demographic variables were scarce and inconsistently documented (Casement & Swanson, 2012; Krakow et al., 2001; Lu et al., 2009; Seda et al., 2015). The lack of documentation and research with varying populations means that further research will be needed before IRT can be recommended for specific groups of persons.
Along with understanding the evidence for IRT, it is also important to consider where IRT fits within Herman’s (1997) tri-phasic model. Imagery Rehearsal Therapy seeks to address nightmares which are a symptom of PTSD. The presence of nightmares has the ability to create dysregulation for trauma survivors. Since learning to calm nightmares through imagery rehearsal can help persons with trauma stay within the window of tolerance, IRT best fits within Phase I of Herman’s (1997) tri-phasic model which focuses on creating safety within the
person.
One last consideration for practitioners considering Imagery Rehearsal Therapy is the accessibility of training for the intervention. Since IRT is a CBT, the website for the academy of cognitive therapy was searched to see if training was provided; it was not. A google search for training yielded one result from a website providing continuing education credits for clinicians working New Mexico. In their 2006 article, Krakow and Zadra outline the protocol for implementing Imagery Rehearsal Therapy with clients. The Krakow and Zadra (2006) article provides the information which clinicians will need to implement IRT into their practice making IRT a relatively easy therapy to learn and utilize.
Imagery Rehearsal Therapy is a cognitive behavioral therapy which seeks to help persons who are experiencing trauma-related nightmares by working within Phase I of Herman’s (1997) tri-phasic model.
Research shows IRT to be as effective as other treatment options and has been rated a Level A treatment due to the amount of evidence which exists for the therapy; these factors make IRT a plausible option for helping persons experiencing trauma-related nightmares (Aurora et al., 2010; Casement & Swanson, 2012; Krakow et al., 2001; Lu et al., 2009; Seda et al., 2015). Unfortunately, research which was located for IRT poorly tracks demographic information which means that further research will be needed before IRT can be recommended for diverse populations (Casement & Swanson, 2012; Krakow et al., 2001; Lu et al., 2009; Seda et al., 2015). Limited training options were located for learning IRT; however, Kakrow and Zadra (2006) outline a protocol for implementing IRT with clients which makes dissemination to therapists relatively easy. The combination of these factors makes Imagery Rehearsal Therapy a relatively good option for clinicians working with persons experiencing trauma-related
nightmares.