What's Imagery Rehearsal Therapy And What Does It Treat?

Medically reviewed by Arianna Williams, LPC, CCTP
Updated June 21, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.
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It can be possible to overcome nightmares

Imagery rehearsal therapy (IRT) is a type of cognitive-behavioral therapy that is often used to help people who experience symptoms of nightmare disorder, like frequent or recurring nightmares. It is most frequently used for the treatment of nightmares related to post-traumatic stress disorder (PTSD). In IRT, the first step is usually to talk about and write down the nightmare’s narrative in as much detail as possible. Next, it’s typically time to reimagine and rewrite the dream with a more positive, empowering ending or more lighthearted details. Finally, as you’re going to sleep, it can be important to imagine having a more positive version of the dream in order to induce it. IRT can be finished in person or online with a licensed therapist and is often effective in reducing nightmares and enhancing sleep quality for improved physical and mental health.

What is imagery rehearsal therapy?

Imagery rehearsal therapy (IRT) is a type of cognitive-behavioral therapy that involves treating patients who are experiencing chronic nightmares, such as those living with post-traumatic stress disorder. Those who have PTSD tend to receive IRT most frequently as a common PTSD symptom tends to be nightmares. IRT can reduce the frequency and severity of nightmares. This treatment’s effectiveness was first shown in a randomized controlled trial of sexual assault survivors. In 2018, the American Academy of Sleep Medicine published a sleep medicine position paper on various treatments to address traumatic content in dreams. Along with other forms of cognitive behavioral therapy, IRT treatment was found to be helpful in creating learned behaviors that helped decrease the frequency and intensity of nightmares for individuals with PTSD. This randomized controlled trial helped spread awareness of this type of therapy and its potential to help people with post-traumatic stress disorder.

Nightmares in patients with PTSD are often incredibly intense. For people living with PTSD, nightmares may take them back to moments that they experienced in real life, usually the ones that led to them developing post-traumatic stress disorder in the first place. Not only may the nightmares negatively impact sleep quality, but they can also make it harder to move past the traumatic event. IRT can reduce the frequency and severity of nightmares by reimagining and inducing dreams with more positive details and endings. This therapy can be used not only for posttraumatic stress but also for those experiencing bad dreams as a symptom of diverse psychiatric diagnoses, like anxiety or panic disorder, which can also negatively impact mental health.

How to get started

Sometimes, talking about your nightmares may not be easy and can have the potential to bring you back to a very traumatic moment in your life. For this reason, imagery rehearsal therapy (IRT) often begins with the weakest or least upsetting nightmare that you have been experiencing. Your therapist will generally want to prevent the risk of an emotional trigger to help build your confidence in the IRT process. Starting small with the weakest nightmare often makes the more intense nightmares easier to tackle later on. 

Write down your dream’s narrative

To start, you’ll usually write down the narrative of your dream, including as many details as possible. Sometimes, the best way to go about this is to have a pen and paper near your bed. When a nightmare wakes you up, you can write down what you experienced while it’s still fresh in your mind. 

Not all PTSD patients may be comfortable enough to write down the narratives of their nightmares on their own. In this situation, a therapist or some type of personal support may need to be present. If you’re living with post-traumatic stress disorder, this can be an important topic to discuss with your therapist.


Rewrite the dream with a positive ending

Now that you have written down the dream that has been bothering you, it may be time to rewrite it. You might discuss the dream with your therapist and then write a positive ending to it. Instead of the dream ending with something tragic or tough for you to handle, you might take action in your dream or turn the situation around in a way that shows you are in control. 

Do not be afraid to use your imagination when coming up with your new positive ending if you want to. You may even take inspiration from your favorite movies or heroes. The new dream ending can be something entirely off the wall if necessary. The intention is merely to turn the dream into something that makes you feel better rather than worse. Coming up with a more positive ending to the nightmare can be empowering for those living with post-traumatic stress disorder or other mental health challenges leading to nightmares.

Imagine the positive version of the dream just before bed

Now that you have rewritten the dream, you may use it to your advantage. Before falling asleep at night, you might try to imagine the positive version of the dream that you just wrote. This technique is commonly known as inducing the intention to dream. Through pleasant imagery exercises, you are preparing your mind to dream about what you want to.

You can think or speak to yourself while you are going through this dream induction process. You might tell yourself that you are going to use the positive version of the dream. If you are going to start having the same nightmare that you usually do, then it is going to end in a new, positive way rather than how it usually does. Continue repeating this to yourself and imagining the positive version of the dream until you drift off to sleep.

Over time, you may find you have success when you treat nightmares with this method. Many PTSD patients and others who live with severe nightmares have had success using this positive dream technique, reducing nightmares and boosting daytime energy. It may not happen the first time, but you’re likely to notice positive changes as you move through imagery rehearsal treatment.

It can be possible to overcome nightmares

Online counseling for PTSD

While traditional in-office therapy may be an option for you, you may feel more comfortable connecting with a licensed therapist online and starting dream therapy to assist you in becoming a dream expert. This may be particularly helpful if you’re interested in imagery rehearsal therapy because you could potentially connect with your therapist before going to bed and talk through the more positive version of your dream together before going to sleep. Online therapy often allows you to connect with a therapist at times outside of regular office hours

As this study explains, online imagery rehearsal therapy can be effective in decreasing the frequency and severity of nightmares. It can be possible to get better sleep and improve your quality of life, so please be sure to reach out for help if you need it.


If you live with frequent nightmares due to traumatic events or post-traumatic stress disorder, you may find that imagery rehearsal therapy (IRT) is a helpful treatment for you. IRT is a cognitive-behavioral approach that is often used to reduce the frequency and severity of nightmares for people with diverse psychiatric diagnoses suffering from bad nighttime dreams. This type of therapy is generally backed up by the results of a randomized controlled trial. The randomized controlled trial reported that IRT could reduce the frequency and intensity of nightmares. The process begins with writing down the disturbing dreams in great detail before rewriting them to be less frightening and more positive. Before going to sleep, it can then be important to visualize the positive version of the dream in order to induce it rather than having the usual nightmare. Not everyone with nightmares and other symptoms will see improvement with this type of cognitive behavior therapy. Other forms of therapy that deal with traumatic experiences include exposure therapy, EMDR, or cognitive processing therapy. You may connect with a therapist who offers IRT or any of these alternative services to reduce nightmares either in person or through an online therapy platform.

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