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Imagery rehearsal therapy is simple: you begin by imagining a dream you would like to have. The dream doesn't have to be some optimistic reverie about puppies and sunshine. You can imagine any dream you want--boring, anodyne, even gloomy--just not your nightmares. You then write down the new one, and every day, you take a few minutes, preferably with eyes closed, to think about that dream.
The JAMA paper showed remarkable results. Patients who underwent imagery rehearsal therapy dropped from an average of six nightmares per week to just two or three. The IRT patients reported 40% fewer PTSD symptoms such as shame and numbness. The patients in a control group who had been waitlisted for IRT--but who had spoken with a psychologist about their bad dreams--actually showed a small increase in their number of nightmares. The findings held up even after six months, and further studies have replicated the JAMA research.
I tried IRT for my nightmares and found it useful. But I was skeptical. Various studies have shown that prazosin is just as beneficial as IRT in helping people have better dreams, which raises a crucial question: Are dreams psychological, physiological or both? And if we don't know, how can we understand the sleeping brain?
In our conversations, Germain had repeatedly mentioned one of her mentors, Dr. Barry Krakow, the primary author of the JAMA paper. With some diplomatic restraint, she said he had since become "controversial" because although he still uses IRT in his practice, he has developed an unusual theory about how best to treat nightmares.
Breathing Lessons
I met krakow at his new Mexico sleep lab, the Maimonides International Nightmare Treatment Center, which sits incongruously in a dreary Albuquerque office park alongside mortgage firms and title companies.
Krakow, 63, started his career as an emergency-room doctor at the University of New Mexico School of Medicine, but in his spare time, he began working with two UNM psychiatrists, Robert Kellner and Joseph Neidhardt, who were developing the idea that dreams could be controlled with daytime therapy. Their idea formed the germ of IRT and eventually led to the JAMA paper.
Since its publication, Krakow has become an acclaimed figure in sleep research, and patients from around the world travel to Albuquerque to see him. But in the past decade, after seeing at least 2,000 people with insomnia and bad dreams, Krakow has become convinced that a rather simple physiological problem might explain most bad dreams: having trouble breathing.
It's not just a hunch. When you sleep at Krakow's lab, a technician attaches 16 sensors to your head, chest and legs. A tube is affixed to your nostrils. For most patients, the ordeal is uncomfortable, but eventually they fall asleep.