Working With Dreams and Nightmares: A Review of the Research Evidence

In this article, we describe methods for working with dreams and nightmares in individual psychotherapy, provide clinical examples, and review research evidence of immediate and distal outcomes of each method. An original meta-analysis of eight studies using the cognitive-experiential dream model with 514 clients showed moderate effect sizes for session depth and insight gains. In the nightmare treatment literature, a previous meta-analysis of 13 studies with 511 clients showed moderate to large effects in reducing nightmare frequency and small to moderate effects in decreasing sleep disturbance for imagery rehearsal therapy and exposure, relaxation, and rescripting therapy. Limitations of the current meta-analysis of cognitive-experiential dreamwork and of the reviewed research on nightmare methods are described. Training implications and therapeutic practice recommendations are provided. Clinical Impact Statement Question: This article describes one method for working with dreams and three methods for working with nightmares in psychotherapy and presents empirical evidence of the efficacy of these methods. Findings: We provide definitions of key terms, clinical examples of each approach, empirical evidence of the efficacy of each approach, treatment recommendations, and special considerations for clinical use. Meaning: Working with dreams in psychotherapy promotes session depth and insight into the dream, and nightmare treatments that limit exposure and those that maximize exposure to nightmare content both have clinical impact on frequency and severity of nightmares, sleep disturbance, and posttraumatic stress. Next Steps: Future research should focus on session process factors of dreamwork (such as therapeutic alliance) and on treatment response variability in exposure and nonexposure methods for working with nightmares.