Taking the Fear out of Children’s Dreams Following a Disaster: The Wonder of Imagery Rehearsal Therapy

Carolyn Levers-Landis, Ph.D.

Consider what happens when children experience seemingly uncontrollable events from a disaster.  They might have seen or heard things that were physically threatening and emotionally frightening.  They might have experienced losses, such as the serious illness or even death of family members.  Spending a lot of time during the day thinking about these events and fearing for their own and others’ safety is common, and some children develop traumatic stress symptoms, including insomnia and nightmares.

Right after having a bad dream, a child might race into their parents’ bedroom to be comforted and tell them all about the dream they had.  They describe in vivid detail what they saw, heard, and did, and the terror that they felt.  Parents listen raptly and comfort their child—they might allow the child to crawl into bed and sleep the rest of the night with them.  

Parents might start regularly asking, “Did you have any bad dreams (or “nightmares”) last night?”  The child becomes primed to pay particular attention to having any scary dreams.  When they happen again, the same process plays out repeatedly.  Scary dream, race into parents’ bedroom, tell them all about it, cuddle up and go back to sleep.  

As the child gets into the habit of having these scary dreams, they might start to get upset at bedtime and anticipate that they will experience the terror of the same dream.  They might try to stay up later, avoiding falling asleep (and therefore having the dream).  They might want to start out in the parents’ bed so that they might not have the dream, or they will be comforted even more quickly.  This can go on for weeks, months, and even years.

There is a way out of this cycle—it is through a simple therapeutic technique called imagery rehearsal therapy (IRT).  Barry Krakow, M.D. developed this strategy originally for adults who were having frequent nightmares that were disrupting their sleep and causing them considerable distress (REFS?).  Research has shown that IRT is effective for children as well (REFS).  IRT breaks the cycle for children by encouraging them to focus on positive imagery and changing their helpless feelings to the expectation that they have control over their dream content.  

Here’s how it works:

• Stop talking about details of any “bad dreams” – do not “rehearse” scary stuff.

• • Ask the child about preferred dreams—“What would you rather dream?”

• Unicorns and rainbows
• Hamsters bowling (a recent preferred dream of one of my young patients)
• Exploring the rain forest
• Eating at an underground restaurant (reminiscent of a scene from a favorite video game)
• Riding on a flying dragon, doing loop-de-loops
• Encourage the child to think through their new dream using all five senses (example of hamsters bowling).
• What do you see?  (e.g., hamsters rolling down the lane, knocking down pins)
• What do you hear? (e.g., music playing, squeaking)
• What might you be eating/drinking? (e.g., popcorn, pop)
• What do you smell? (e.g., melted butter from the popcorn, bowling shoes – ha!)
• What do you feel? (e.g., feel of the soft hamsters, smooth bowling ball)
• Figure out a time during the day to practice the dream for 10-15 minutes.
• After school before doing homework.
• At dinnertime while parent is fixing food.
• At nighttime as part of the bedtime routine.
• Be creative when practicing the new dream
• Draw pictures
• Make crafts
• Use stickers
• Write a book
• Tell a story
• Tell the child and parent(s) caveats about dreams – we do not remember most of them!
• We only remember a small fraction of our dreams (about 10%) – so the child might be having the dream and not remember it.
• It is still normal to have dreams we do not like sometimes.
• Follow up to find out if there were any challenges with practicing the new dream
• Could change to a different topic after a while as needed

• Celebrate – bad dream erased with good dream!