You Can Rewrite a Recurring Nightmare
Most people treat a recurring nightmare the way they treat weather: as something that happens to them, to be endured until it passes. What surprises many is that frequent, distressing nightmares can be a recognized condition, called Nightmare Disorder, with an actual treatment. With the guidance of a clinician trained in behavioral sleep medicine, you rewrite the dream while you’re awake.
An occasional bad dream is a normal part of life. This is about nightmares that keep coming back, cause real distress, or interfere with sleep and daily functioning.
What Imagery Rehearsal Therapy is
The technique is called Imagery Rehearsal Therapy (IRT). It works like this: you take a nightmare that keeps returning and, with the support of a therapist, change the storyline. The aim isn’t to force a happy ending but to rework it into something less threatening, more neutral, or even a little empowering. Then you rehearse the new version in your imagination, regularly.
Many people find that their nightmares become less frequent and less intense. IRT is a behavioral technique from the cognitive-behavioral family of approaches, the same broad family as CBT-I. It’s practical, learnable, and doesn’t require medication. International treatment guidelines list it as a first-line treatment for Nightmare Disorder.
Because the work involves revisiting distressing material, it’s best done with a trained clinician, especially if trauma is part of the picture.
What a recent study found
In a 2025 clinical study, researchers followed 53 adults who had both a major depressive episode and Nightmare Disorder. Some received IRT. The comparison group received sleep education while waiting for IRT.
The IRT group showed greater improvement in nightmare severity than the comparison group. Their depression and anxiety symptoms also improved, which fits with other research linking sleep problems and mood.
A few cautions apply. Participants weren’t randomly assigned to groups, and the study was small, so the results show an association rather than proof that IRT caused the improvements. The participants also all had a diagnosed major depressive episode, so the findings don’t automatically apply to everyone who has nightmares.
The researchers also tracked suicidal symptoms, which improved in the IRT group. This has to be stated carefully. That improvement was associated with the nightmares and depression easing. IRT is not a treatment for suicidality, and no one should read it as one.
If you are struggling with thoughts of suicide, you can call or text 988 to reach the Suicide & Crisis Lifeline, any time.
Why this matters
Nightmares are one of behavioral sleep medicine’s quieter specialties. They’re common after trauma, in PTSD, and alongside depression, yet they’re rarely discussed as something with a fix. People often assume they just have to white-knuckle through them. IRT is a reminder that a recurring nightmare is not a life sentence, and that behavioral strategies for it have been shown to work.
What to take from this Recurring, distressing nightmares are a treatable condition, not just something to endure. IRT is a real, non-drug option, best done with a trained clinician who can guide the rewriting, especially when trauma is involved. Early evidence suggests that treating nightmares may also ease depression and anxiety, but this needs confirmation in larger, randomized studies. Serious mood symptoms and any thoughts of suicide deserve direct care. Source Maruani J, Martins N, Clerici E, Lejoyeux M, Geoffroy PA. Imagery Rehearsal Therapy (IRT) is associated with reduced nightmare severity and depressive, anxiety and suicidal symptoms in adults with Major Depressive Episode. International Journal of Clinical and Health Psychology. 2026;26:100658. https://doi.org/10.1016/j.ijchp.2025.100658
Educational content, not individualized medical advice.