To the Editor: Imagery rehearsal therapy is an efficacious treatment for chronic nightmares. In one controlled study using this therapy, chronic posttraumatic stress symptoms decreased as well (1). However, imagery rehearsal therapy has not been tested on acute nightmares or acute posttraumatic stress symptoms. The following case series describes the use of imagery rehearsal therapy with U.S. Army combat soldiers deployed to Iraq. Only soldiers with a primary complaint of acute nightmares received treatment.

Her car is racing at a terrifying speed through the streets of a large city, and something with giant eyeballs is chasing her, closing in fast. It was a dream, of course, and after Emily Gurule, a 50-year-old high school teacher, related it to Dr Barry Krakow, he simply told her to think of a new one. “In your mind, with thinking and picturing, take a few minutes, close your eyes, and I want you to change the dream any way you wish,” said Dr Krakow, founder of the Post Traumatic Stress Disorder (PTSD) Sleep Clinic at the Maimonides Sleep Arts and Sciences centre in New Mexico, US, and a leading researcher of nightmares.