More threads by Hunter


I have an extensive trauma history. I am on numerous medications. Medications to help with PTSD, depression, anxiety and panic attacks. I have always been plaqued with nightmares mostly of all the physical, emotional, and sexual abuse. However, for the past 2 weeks I've been having horrible nightmares of my family dying in motor vehicle accidents, fires, and drownings. After these nightmares, how can you try and go back to sleep. Not sure why they are happening and not sure how I can stop them.

Daniel E.
I would be curious how much ACT or acceptance in general could help. Because the more you try to avoid the nightmares or anxiety, the more distressing these unwanted experiences will seem. In other words, it is a paradox: "If you don't want it, you've got it." The behavioral goal of ACT therapy is doing what you value rather than trying to manage symptoms per se:

Many trauma survivors with PTSD have tried numerous things to rid themselves of their symptoms only to find that many of these efforts have failed. They’ve used alcohol to control anxiety or isolation to control fear, for instance. These efforts are most often about trying to have some other experience than the current one that is happening in the here and now. These efforts can be fundamentally flawed, however, in that it is a “first you lose then you play” game...

ACT specifically targets experiential avoidance and is largely focused on changing one’s life rather than changing one’s insides...Acceptance of internal experience is key in this process. The client is asked to be willing to feel what she feels, notice what she thinks, be aware and mindful, and make and keep commitments that are consistent with her personal values.

Have you tried image rehearsal therapy before?

For example:

Instead of focusing on the bad dream, imagery therapy looks for ways to rewrite a nightmare’s script. The concern is that talking too much about a troubling dream may serve to reinforce it. Imagery rehearsal therapy allows the dreamer to rewrite the nightmare during the day. After practicing basic imagery techniques — imagining yourself on a beach or eating a hamburger, for example — the troubled dreamer chooses a better version of the dream, explains Shelby Harris, clinical psychologist at the Sleep-Wake Disorders Center at Montefiore Hospital in New York.

“We mention the nightmare once and forget about it,” Dr. Harris said. “I tell patients to change it anyway they wish. You can change a tiny bit of it, or change the whole thing.”

Imagery Rehearsal Therapy [IRT] (Recommended) Level A: is a modified CBT technique that utilizes recalling the nightmare, writing it down, changing the theme, story line, ending or any part of the dream to a more positive one, and rehearsing the rewritten dream scenario so that the patient can displace the unwanted ending when the dream recurs. IRT acts to inhibit the original nightmare, providing a cognitive shift that empirically refutes the original premise of the nightmare. This technique is practiced for 10-20 minutes per day while awake.

The article above also suggests progressive muscle relaxation :acrobat:, which can help lower one's baseline anxiety (not unlike exercise or meditation).

I read some meds for high blood pressure like prazosin or clonidine are also given to help with PTSD nightmares.

What meds are you on now? Have you tried trazodone or an antipsychotic to help with PTSD/nightmares?

I am on a relatively-high dose of Prozac (80 mg) and can remember my dreams now every morning when I wake up. The dreams I remember also seem more vivid when I have them. But I don't have distressing nightmares or PTSD.

Some previous info:

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I used to have nightmares of what happened to me but now it's of other horrible things. Meds are duloxetine taken in morning, mirtazapine, Seroquel 25 mg and Seroquel 300 and Gabapentin for chronic pain. I have been on these meds since 2008. I also take a sleeping pill zopiclone, but all it does is make me feel groggy in the morning with a horrible taste in my mouth. I have to take an oxycodone pill at night that helps greatly with my chronic pain. Maybe it's time to consult with my doc about changing them.
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