Imagery Rehearsal Therapy for trauma-affected refugees – A case series

Psychotherapy for nightmares and sleep disturbances in refugees suffering from post-traumatic stress disorder (PTSD) is an unexamined area. This case study examines efficacy, acceptability, and patient experiences with Imagery Rehearsal Therapy (IRT) in 8 refugees with Middle Eastern background and PTSD-related nightmares. The aims of the study were to examine: A. if changes before and after IRT can be detected on measures of sleep quality, PTSD, level of functioning, and quality of life, B. if IRT is acceptable to refugees with PTSD-related nightmares, and C. patients’ individual and shared experiences through the three stages of IRT including changes in nightmare frequency on a sleep log. Qualitative (open questions) and quantitative methods (sleep-log, structured measures, drop-out, cancellation-, and no-show rates) were applied in order to create a thick description of the patients’ experiences throughout their IRT treatment process. Despite relatively high drop-out, cancellations and no-show rates; findings indicate that IRT is acceptable for the patients included in this study. Furthermore, a reduction in nightmare frequency, improvement in sleep quality and daytime functioning was indicated for most patients. IRT seems to be a good non-trauma-focused alternative to trauma-focused therapy for trauma-affected refugees and might also be used as an add on to standard trauma-focused treatment.