Supplementary Material for: Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial

Introduction: Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. Objective: The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. Methods: In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. Results: Nightmare distress was reduced in all groups (imagery rescripting: Cohen’s d = –1.04, imaginal exposure: d = –0.68, positive imagery: d = –0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. Conclusions: Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.引言：与等待列表对照组（waitlist condition）相比，意象重构（imagery rescripting）与想象暴露（imaginal exposure）均已被证实可有效治疗慢性噩梦（chronic nightmares）。但目前学界对二者的比较疗效，以及二者与主动对照（active control）相比的疗效仍知之甚少。 研究目的：本研究旨在对比两种治疗方案的疗效，并将其与作为主动对照的积极意象（positive imagery）疗法进行比较，同时探索治疗效应的协变量（covariates）。 研究方法：本项单盲随机对照试验（single-blinded randomized controlled trial）共纳入来自门诊诊所（outpatient clinic）的96名符合特发性噩梦（idiopathic nightmares）诊断标准的噩梦障碍（nightmare disorder）患者，将其随机分配至接受单次个体治疗疗程：分别为意象重构、想象暴露或积极意象疗法，并辅以为期4周的家庭练习。本研究的主要结局指标（primary outcome）为噩梦痛苦程度（nightmare distress），次要结局指标（secondary outcomes）包括噩梦频率（nightmare frequency）、噩梦影响（nightmare effects）、自我效能感（self-efficacy）与一般精神病理学（general psychopathology）水平。 研究结果：所有组别患者的噩梦痛苦程度均有所降低（意象重构：科恩d值（Cohen’s d）= –1.04，想象暴露：d = –0.68，积极意象：d = –0.57），噩梦频率、噩梦影响与精神病理学水平亦呈现相同下降趋势。自我效能感得到显著提升。在所有主要或次要结局指标上均未观察到显著的差异治疗效应（differential treatment effects）。治疗获益（treatment gains）与人口统计学特征（demographic characteristics）、疾病特征、基线值（baseline values）、治疗可信度（treatment credibility）及家庭练习次数均无关联。 研究结论：即便短疗程的噩梦治疗方案同样有效，且不受个体特征影响，不同干预手段均可取得相近的治疗效果。未来研究应致力于阐明其作用机制（mechanisms of action），医疗保健领域应更广泛地应用这些强效且易于实施（easy-to-administer）的噩梦治疗方案。