Image rehearsal therapy worksheet

What is the theory behind this Image rehearsal  therapy worksheet?

Image rehearsal therapy IRT is a treatment method for reducing the frequency and intensity of nightmares, more specifically experienced during Post Traumatic Stress Disorder (PTSD). Nightmares are vivid dreams having anxiety provoking content. The dreamer usually sees himself being attacked or in danger. Constant nightmares lead people to cope with them through avoidance, i.e. preventing themselves from falling asleep that further adds to the mental health distress. 

How will the worksheet help?

This worksheet will help the clients towards reducing the intensity of their nightmares and help them sleep better. By re-scripting the alternate ending of the trauma related nightmares, the fear around it will decrease. Keeping track of it on the log will help in scheduling and performing the activity. 

How to use this worksheet?

The client is required to focus on one dream at a time. Begin this activity with a less frightening nightmare. Fill in the spaces on the table with appropriate responses. Focus on your thoughts and feelings. Then practice visualizing the alternate ending twice or thrice a day for 20 minutes. Fill the nightmare log to keep track.

Image rehearsal therapy worksheet

Nightmare log

Dream 11st  practice for 20 min2nd practice for 20 min3rd practice for 20 min


Krakow, B., Johnston, L., Koss, M., Schrader, R., Warner, T. D., Tandberg, D., Lauriello, J., McBride, L., Cutchen, L., Cheng, D., Emmons, S., Germain, A., Melendrez, D., Sandoval, D., & Prince, H. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder. JAMA, 286(5), 537.

Yücel, D. E., van Emmerik, A. A. P., Souama, C., & Lancee, J. (2020). Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 50, 101248.

You can download this worksheet here.

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