Nightmare Rescripting Worksheet
An imagery rehearsal therapy (IRT) worksheet for recurring nightmares: a brief outline, a rewritten dream, and a daily rehearsal log tracking nightmare frequency and distress.
2-page fillable PDF · US Letter (prints on A4) · Imagery rehearsal therapy
- Approach / concern
- Trauma & PTSD
- Technique
- Imagery rehearsal therapy
- Format
- Fillable PDF, 2 pages (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the Nightmare Rescripting Worksheet?
Imagery rehearsal therapy is a cognitive-behavioural treatment for chronic nightmares. The person selects a nightmare, changes it in any way they wish while awake, and rehearses the new dream imagery daily. It treats nightmares as a learned sleep behaviour that can be modified (Krakow & Zadra, 2006).
Why it works
Meta-analysis shows imagery rehearsal reduces nightmare frequency and improves sleep quality and PTSD symptoms in trauma-exposed adults (Casement & Swanson, 2012). It is brief, well-tolerated and can be delivered alongside other trauma treatment.
When to use it
- Trauma-related nightmares
- Idiopathic recurring nightmares
- PTSD with sleep disturbance
- Alongside CBT-I
How to use it in session
- Provide psychoeducation about nightmares as a learned pattern.
- Choose a less distressing nightmare to start.
- Help the client write a changed version (any change is fine).
- Assign 10-20 minutes of daily imagery rehearsal.
- Track frequency and distress, then move to other nightmares.
Clinician tips
- Clients don’t need to describe trauma details for IRT to work.
- Encourage creativity; absurd changes are fine.
- Screen for sleep apnea when nightmares co-occur with poor sleep.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Do I have to relive the trauma to do IRT?
No. IRT focuses on creating and rehearsing new imagery, not on retelling traumatic details.
How quickly does imagery rehearsal work?
Many people notice fewer or less intense nightmares within a few weeks of daily rehearsal.
References
Krakow, B., & Zadra, A. (2006). Clinical management of chronic nightmares: Imagery rehearsal therapy. Behavioral Sleep Medicine, 4(1), 45-70.
Casement, M. D., & Swanson, L. M. (2012). A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress. Clinical Psychology Review, 32(6), 566-574.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
