Posttraumatic Nightmares

Project Details

Phoenix Australia - Centre for Posttraumatic Mental Health, (Phoenix) in collaboration with Austin Health Veterans Psychiatry Unit, conducted an early pilot trial of imagery rehearsal (IR) therapy in 2001. The success of this trial has led to investigation of the nature of the phenomenon of posttraumatic dreams – whether they are better understood and treated as intrusive symptoms of PTSD or as dreams that have become stuck in a cycle of chronic repetition.

The efficacy of IR has continued to be investigated, with around 20 trials internationally. Unfortunately, much of the research continues to be low quality. Phoenix is currently collaborating on a randomised controlled trial of CBT for insomnia versus CBT for insomnia + IR for U.S. veterans returning from Iraq and Afghanistan with Philadelphia VA, Department of Psychiatry at University of Pennsylvania and Department of Psychiatry at Yale School of Medicine. Future research will investigate whether IR is more or less effective for different types of posttraumatic nightmares, including those that replay traumatic experience versus those that are symbolic, and those that are more like daytime intrusions of PTSD versus those that are more like normal dreams. This research will have important treatment implications.

Phoenix is also collaborating with Austin Health Sleep Clinic and Post Trauma Recovery Service (PTRS) to undertake an investigation of the sleep factors that underpin posttraumatic nightmares, using ambulatory polsomnography. Key questions to be addressed in this research include: Are posttraumatic nightmares restricted to REM sleep or can they occur across other stages of sleep?; Are posttraumatic nightmares associated with sleep disorders such as obstructive sleep apnoea? Does dream phenomenology differ depending on the stage of sleep and/or the presence of underlying sleep disorder?


Dr Andrea Phelps

Professor David Forbes



Behavioral Health Service, Philadelphia VA Medical Centre, Philadelphia, Pennsylvania, USA

Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Department of Psychiatry, Yale School of Medicine and National Center for PTSD, West Haven, Connecticut, USA


Psychological Trauma Recovery Service (PTRS), Austin Health

Institute for Breathing and Sleep (IBAS), Austin Health


Investigation of sleep factors underpinning posttraumatic nightmares: Defence Health Foundation

Imagery rehearsal RCT: US Department of Defense, Congressionally Directed Medical Research Program (CDMRP)

Research Publications

Phelps, A.J., Creamer, M., Hopwood, M. & Forbes, D. (2014) Features of posttraumatic dreams related to PTSD severity.  Journal of Traumatic Stress Disorders & Treatment 3:3

Harb, G., Phelps, A., Forbes, D., Ross, R., Gehrman, P. & Cook, J. (2013) A Critical Review of the Evidence Base of Imagery Rehearsal for Posttraumatic Nightmares: Pointing the Way for Future Research. Journal of Traumatic Stress, 26, 570-579.

Phelps, A. & Forbes, D. (2012) Treating posttraumatic stress disorder-related dreams: What are the options? Editorial, Expert Review of Neurotherapeutics12 (11): 1267-1271.

Phelps, A., Forbes, D., Hopwood, M., & Creamer, M. (2011) Trauma-related dreams of Australian veterans with PTSD: content, affect and phenomenology. Australian and New Zealand Journal of Psychiatry, 45: 853-860

Phelps, A.J., Forbes, D. & Creamer, M. (2008) Understanding posttraumatic nightmares: An empirical and conceptual review.  Clinical Psychology Review. 28: 339-356.

Forbes, D., Phelps, A.J., McHugh, A.F., Debenham, P., Hopwood, M. & Creamer, M. (2003) Treatment of combat-related nightmares using Imagery Rehearsal – twelve month follow up data Journal of Traumatic Stress, 16(5), 509-513.

Forbes,D., Phelps, A.J., & McHugh, A.F. (2001). Treatment of combat-related nightmares using Imagery Rehearsal: Journal of Traumatic Stress, 14(2), 433-442.

Research Group

Trauma Research Group

Faculty Research Themes


School Research Themes

Neuroscience & Psychiatry

Key Contact

For further information about this research, please contact the research group leader.

Department / Centre


Unit / Centre

Trauma Research Group

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