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Understanding Nightmares and Their Potential Increase During PTSD Therapy

Post-Traumatic Stress Disorder (PTSD) therapy can be a transformative and healing journey for individuals recovering from traumatic experiences. However, it is not uncommon for some individuals to experience an increase in nightmares during the course of therapy. In this blog post, we will explore why nightmares may intensify during PTSD therapy, how they relate to the healing process, and strategies to manage them effectively.

Understanding Nightmares

1. Understanding Nightmares in PTSD:

Nightmares are vivid and distressing dreams that can occur in individuals with PTSD. These nightmares often revolve around the traumatic event(s) and can disrupt sleep, trigger intense emotions, and contribute to a sense of fear and helplessness. The following factors contribute to the occurrence of nightmares:

a. Memory Consolidation: Nightmares may arise as the brain attempts to consolidate and process traumatic memories during sleep. The mind seeks to make sense of the traumatic experience, resulting in the manifestation of distressing dreams.

b. Emotional Activation: Trauma-related nightmares often elicit intense emotions, such as fear, anxiety, or sadness. These emotions may be an expression of the unresolved trauma and can surface as the mind engages in the therapeutic process.

c. Hyperarousal: Individuals with PTSD often experience a heightened state of arousal, including increased vigilance, irritability, and difficulty relaxing. This hyperarousal can spill over into sleep, making individuals more prone to nightmares.

2. Nightmares and the Healing Process:

While the intensification of nightmares during PTSD therapy may be distressing, it can also be viewed as a positive sign of progress. Nightmares can indicate that the mind is actively processing and integrating traumatic experiences. It is important to remember that the increase in nightmares is temporary and can lead to healing in the long run. Some reasons nightmares may intensify during therapy include:

a. Heightened Emotional Awareness: Engaging in therapy brings emotions and traumatic memories to the surface. This heightened emotional awareness can trigger nightmares as the mind grapples with the intense experiences being addressed in therapy.

b. Memory Reconsolidation: PTSD therapy often involves revisiting traumatic memories in a safe and supportive environment. This process of memory reconsolidation can temporarily lead to an increase in nightmares as the brain attempts to reorganise and heal.

c. Enhanced Emotional Processing: Therapy encourages individuals to confront and process difficult emotions related to the trauma. While this can be challenging, it is an essential part of the healing process. Nightmares may serve as a means for the mind to further process and release emotional distress.

3. Strategies to Manage Nightmares During Therapy:

a. Establish a Bedtime Routine: Implement a soothing bedtime routine that promotes relaxation and prepares the mind for sleep. This may include activities such as taking a warm bath, reading a calming book, or practicing relaxation exercises.

b. Create a Safe Sleep Environment: Make your sleep environment conducive to relaxation by ensuring it is comfortable, quiet, and free from distractions. Use soft lighting or soothing sounds if they help create a sense of calmness.

c. Practice Good Sleep Hygiene: Maintain a regular sleep schedule, avoid caffeine and stimulating activities close to bedtime, and limit exposure to electronic devices before sleep. Good sleep hygiene can contribute to better sleep quality and potentially reduce the frequency of nightmares.

d. Engage in Relaxation Techniques: Learn and practice relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation. These techniques can help reduce overall stress and promote better sleep.

e. Discuss Nightmares in Therapy: Communicate openly with your therapist about the increase in nightmares. They can provide valuable insights, reassurance, and specific techniques to help you navigate and process the nightmares effectively.

f. Imagery Rehearsal Therapy (IRT): IRT is a specific therapeutic technique designed to address nightmares. It involves mentally rehearsing new, positive outcomes for distressing dreams. Consult with a therapist experienced in IRT to explore its potential benefits.


Experiencing an increase in nightmares during PTSD therapy can be challenging, but it is a common phenomenon in the healing process. By understanding the underlying reasons for the intensification of nightmares and implementing effective strategies to manage them, individuals can continue their therapeutic journey with confidence and resilience. Remember to consult with a qualified mental health professional for personalized guidance and support tailored to your specific needs.

Disclaimer: This blog post is for informational purposes only and should not replace professional, medical or mental health advice. If you are experiencing severe nightmares or require assistance with PTSD, it is recommended to seek guidance from a qualified mental health professional.

If you would like CBT or EMDR with one of our therapists, get in touch.


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