DBT Skills: Nightmare Protocol

You can personalize the DBT Skills: Nightmare Protocol resource by downloading it HERE, and adding your own responses, or continue to view it below.

We may all experience an occasional nightmare, waking up with feelings of fear, terror, sadness, or confusion. We may have woken up with a sense that the nightmare was completely real, and experienced physiological responses like sweating, shaking, or a racing heart beat. If we’ve experienced the same nightmares over and over, it may be challenging to get the rest we need or we may avoid sleep altogether. It’s understandable that we don’t want to experience the distress that we feel during and after a nightmare, and at the same time, avoiding sleep can worsen any symptoms that we are experiencing throughout our day. This resource will take us through the steps outlined in the “Nightmare Protocol” from Dialectical Behavior Therapy (DBT), to help us reduce the intensity and frequency of nightmares, and improve our overall quality of sleep.

Steps to the Nightmare Protocol

Step 1: Practice relaxation skills before starting

Practicing these skills first, allows us to emotionally regulate and prepare ourselves to work with any of the challenging emotions and sensations that are associated with the nightmare.

Some suggestions include:

• Beach Visualization (audio)
• Cloud Visualization (audio)
• Deep Breathing
• Mountain Meditation (audio)
• Progressive Muscle Relaxation (script)
• Progressive Muscle Relaxation (audio)

Step 2: Choose a recurring nightmare that you experience

Start with nightmares that are lower in intensity first, and avoid trauma related nightmares, unless working with your therapist. If you and your therapist are working on a trauma related nightmare, skip to step 4.

Step 3: Write out the details of the nightmare

Details include sights, smells, sounds, tastes, and physical sensations. Details also include thoughts, emotions, and beliefs that you might be holding about yourself.

Step 4: Create an “alternative outcome” for the nightmare

Brainstorm a new narrative for yourself, with a change that comes before anything negative happens in the nightmare; this involves anything that happens to prevent the negative outcome. Given dreams are often unusual to begin with, this positive change can involve something out of the ordinary as well (e.g. you become an invincible superhero or you encounter a wise being that gives you guidance). This can also include changes in the way you think or feel, or having other resources become available to you

Step 5: Write out the new narrative, including your changes and the alternative, positive outcome

Step 6: Rehearse, then relax each night

Mentally rehearse the new dream with your changes and the positive outcomes, then use a relaxation exercise, such as those noted in Step 1.

Step 7: Rehearse, then relax, during the day

Visualize the new dream with your changes and the positive outcomes, then practice a relaxation exercise.

Practice

To practice, use the following link to the PDF version of this resource, and follow the prompts at the end.

Alternatively, use one sheet of paper to write out the narrative of the nightmare, including as many details as you can (i.e. sights, smells, sounds, tastes, and physical sensations; thoughts, emotions, and beliefs you might be holding about yourself). Skip if working on a trauma related nightmare.

• Start with: "In the nightmare, I...

On a second sheet of paper write out the narrative of the alternative dream, with the particular changes happening before the challenging parts. Include as many details as you can (i.e. new sights, smells, sounds, tastes, and physical sensations; new strengths, thoughts, emotions, and beliefs you might be holding about yourself).

• Start with: "In the alternative dream, I...

References

• Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.