Cognitive Behavioral Therapy for Nightmares

In-person in Orlando & online across FL, NY & NJ.

Rewrite your dreams and head to bed with confidence.

Afraid to go to sleep?

You’ve dealt with some tough stuff in your life. There may be one instance in particular that sticks out the most, or maybe it’s a smattering of different experiences over your lifetime, but it’s had a complex impact on your life.

You’ve experienced . . .

  • Emotionally painful situations

  • Intense anxiety or panic

  • Chronically stressful or unsafe environments

  • Circumstances that put you or a loved one in danger

The worst part is the nightmares.

Over time you’ve worked through trauma, learned to deal with anxiety and stress in a way that works for you, or just downright avoided the past. But the one thing that you can’t avoid is the nightmares. At least during the day you can distract yourself, stay busy, and focus on other things you care about.

At night, you’ve got no control. You feel totally vulnerable. All the fear floods in and there’s nothing you can do to stop your brain from replaying some of your most painful moments, as if you’re living it over and over.

You’ve tried staying up late, sleeping with the lights on, checking door and window locks throughout the night, playing music, watching movies, meditating, sleeping with weapons near you, sleeping in another room. Nothing works.

 You’ve started to consider that this may just be what sleep is like for you now, but something in you is still fighting, and isn’t ready to give up hope just yet. Because this isn’t just about you and it isn’t just about now.

Nightmares affect your ability to connect with people you love, and your capacity for living a peaceful life.

Nightmares disrupt more than just your sleep. They impact your . . .

  • You’ve tried to keep the pain and struggle to yourself, but the impact spills over despite your efforts. Your partner, friend, or family is worried. They knew you didn’t sleep well, but recently you can tell they’ve become really concerned and this is weighing on them. You don’t want them to worry so you put on a brave face and hide how tired you feel during the day. Somehow the harder you try to ‘be okay’ the less ‘okay’ you are, and it backfires. The fatigue and desperation come out as anger. You’re snapping at your partner and have no patience with your kids, parents, and friends.

  • The more you avoid thinking about the nightmare, the more often it pops into your mind during the day and it takes all your effort to push it away. Sometimes you get stuck in it and it takes hours to shake it off. The lack of sleep makes you feel irritable, and you start to get short with coworkers. You can’t focus at work and feel like you’re either getting behind or just not moving forward.

  • Maybe you’ve been able to hide it well and others don’t know how exhausted you are. It feels like you’re hiding a dark secret, and it’s hard to feel like your real self with your loved ones. They don’t know, but you do.

The idea of getting nightmare treatment is almost as scary as the dream itself, because it means you have to think about it.

As if acknowledging the dream brings it into reality. You fear this will only increase those excruciating feelings (guilt, shame, grief, regret, fear) until they overwhelm you. You’ve avoided addressing it for months or years, but the toll it’s taking on your relationships, your work life, and your general sense of peace just isn’t worth it anymore.

Take Your Power Back.

Cognitive Behavioral Therapy for Nightmares (CBT-N) can help you feel confident, relaxed, and even at peace with some of your scariest dreams.

It’s not that you’ll start dreaming about roses and kittens and rainbows (I mean maybe?, but probably not). It’s that you won’t feel afraid of your dreams anymore and your body won’t jump into hyperarousal during sleep.

People who see me for nightmare therapy say things like . . .

Sometimes I have a dream that has similar themes, but it feels like I’m watching a boring movie from far away. It just doesn’t freak me out like it used to.

I don’t feel so alone anymore.

I don’t find myself worried about the dreams anymore. I have a sense of control over them now.

I went from having seven nightmares a week to one or two, and now they don’t even wake me up.

This has given me a lot of peace and new perspective on the situation I used to have nightmares about.

Stress impacts your body, behavior, and brain.

That’s where we intervene.

On the body side, we identify the roles that physical stress and hyperarousal play in causing nightmares. Then we respond by training the body to move from the sympathetic nervous system to the parasympathetic nervous system by inducing relaxation.

On the behavior side, we notice the ways we’ve responded to nightmares that actually tend to further trap us in them (sleeping with the lights on, perimeter checks, alcohol use, avoiding sleep, avoiding thinking about the nightmare, etc). We experiment with new behaviors that promote rather than prevent sleep.

On the psychological side, we identify the sharpest pieces of the nightmare and change those aspects of the dream, writing out and mentally rehearsing a new version of it. This gives our brain another image to utilize during dreaming that’s different from the one causing us distress.

This is called Cognitive Behavioral Therapy for Nightmares (CBT-N).

Dream Interpretation vs.

Nightmare Treatment

When you think of getting therapy for nightmares, what comes to mind? Laying on a couch, recalling your dream, and the therapist describing what each element symbolizes and what true information it’s giving you about your real life? This is not that.

Dream interpretation is completely different from nightmare treatment. Dream interpretation focuses on creating meaning from the dream and using it to draw conclusions about your waking life. Nightmare treatment doesn’t involve interpreting the dream or drawing any meaning from events that inspired the dream.

CBT-N focuses on decreasing physiological arousal associated with the dream, increasing a sense of calm and confidence regarding sleep, and identifying painful narrative elements that we can alter to give your brain an alternative image to engage with during sleep.

CBT for Nightmares can help you . . .

  • Explore the causes of nightmares

  • Train the body for physical relaxation

  • Replace unhelpful sleep behaviors with helpful ones

  • Rewrite your dreams for undisturbed sleep

  • Enjoy your days and nights with peace and confidence

Rest easy. Wake peacefully.

FAQs

  • A nightmare is a distressing, well-remembered dream that wakes you up from your sleep. It often causes you to wake in fear with heightened physiological sensations like shaking, heart racing, fast breathing, crying, and disorientation. It sometimes causes you to yell out in your sleep. For some, it takes some time of being awake to realize where you are and that you were dreaming. Nightmares typically occur during the REM (rapid eye movement) stage of sleep later in the sleep period.

  • Absolutely, they tend to travel together. Stress is a very cyclical experience where maybe it causes a nightmare, and then because you’re waking often during the night you feel more sleepy during the day. You start to feel worried about how tired you are, and maybe start to anticipate going to bed with anxiety, which creates trouble falling asleep. And then BOOM, you have both nightmares and insomnia! The cool thing about CBT-N is that it incorporates some of the same methods typically used to treat insomnia (CBT-I), and if we decide we need the full version of CBT-I in addition to CBT-N, they can both be done at the same time.

  • Sometimes yes and sometimes no. Research shows that insomnia and nightmares are some of the most common symptoms that stick around after successful treatment of PTSD, and often require sleep-specific treatment such as CBT-I or CBT-N to be fully resolved.

  • Some nightmares stem from a trauma, and others stem from a complex combination of other factors, primarily stress and heightened mood states during the day. CBT-N is an effective treatment for both causes of nightmares.

  • Yes. This is a great treatment option for someone who doesn’t want to go into the details of a really painful real-life experience. It does involve discussing the details of the actual nightmare, but not discussing the true traumatic event. Even if the nightmare feels like a replay of the trauma, there are usually some details that are different or not exactly the same.

  • No. Some people experience repetitive nightmares where the dream content is usually the same each time. Others experience nightmares that are different each time, sometimes with similar themes and sometimes not. This treatment is effective for both. This treatment may not work for you if you can’t remember any of your nightmares.

  • You can absolutely do CBT-N and see results whether you are currently taking a sleep med, have recently come off a sleep med, or have never taken a sleep med. We’ll create your treatment plan collaboratively based on your goals. If you wish to decrease or discontinue a sleep med, we can make that a part of our work, in collaboration with your prescriber, but it isn’t required.

  • My fee is $285 per 45 minute session. 

    I am considered an Out of Network (OON) provider which means I don’t accept any insurance, however I can provide you with a superbill that you can use to request reimbursement from your insurance company if you have any Out of Network benefits. I encourage you to ask me for a sample superbill, then call your insurance provider to ask about your out of network benefits and if my services would be covered.

  • After a full evaluation session, CBT-N typically lasts between 4 - 8 sessions.