Thank you for your service. This Imagery Rehearsal Therapy (IRT) worksheet is designed to support veterans and individuals living with PTSD who experience recurring nightmares related to past trauma. Nightmares are a common and understandable response to experiences where the brain remains in a state of heightened alertness, even long after the danger has passed. IRT is an evidence-based approach that helps you safely change the pattern of these dreams by creating a new, less distressing version and practicing it while awake. This process allows your brain to build alternative pathways, reducing the intensity and frequency of nightmares over time. This structured, printable worksheet helps you identify patterns, regain a sense of control, and improve sleep while reinforcing grounding and emotional regulation skills—all at a pace that prioritizes your safety and comfort.

Imagery Rehearsal Therapy Nightmare Worksheet

PTSD Nightmares • Sleep Recovery • Trauma-Informed Rehearsal Practice

Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ADHD-CCSP, C-DBT, CCTP, CCPT II

Client Information

Name Date

What Is Imagery Rehearsal Therapy?

Imagery Rehearsal Therapy, or IRT, is a trauma-informed method used to reduce recurring nightmares. The goal is not to force yourself to relive the nightmare. Instead, the goal is to gently rewrite the ending or direction of the dream while awake, then rehearse the new version so the brain has a safer pathway to follow during sleep.

Nightmares often occur when the nervous system remains activated and the brain continues trying to process danger, fear, or helplessness. IRT helps create a sense of control, safety, and mastery by changing the dream image into something less threatening.

Step 1: Identify the Nightmare Pattern

Briefly describe the recurring nightmare without including overwhelming details.

Nightmare distress before rehearsal (0–10)

Nightmare frequency this week

Sleep quality this week (0–10)

Step 2: Identify the Emotional Theme

What feeling is strongest in the nightmare? What does the nightmare seem to be replaying emotionally?

Step 3: Create a New Version

The new dream does not have to be realistic. It only needs to help your brain experience control, protection, escape, support, or resolution.

How would you like the dream to change? New dream ending or safer version: What feeling should the new version create?

Step 4: Rehearsal Practice

Practice the new version for 2–5 minutes during the day, not right before sleep if it feels activating. The goal is gentle repetition, not perfection.

I practiced the new dream version today I kept the rehearsal brief and manageable I used grounding before or after rehearsal I reminded myself that I am safe in the present I stopped before becoming overwhelmed What helped me feel grounded after rehearsal?

Step 5: After-Rehearsal Ratings

Distress after rehearsal (0–10)

Sense of control after rehearsal (0–10)

Sense of safety after rehearsal (0–10)

Self-Scoring

Calculate Progress Download / Print PDF

Complete the worksheet and click Calculate Progress.

Clinical Summary

Client completed an Imagery Rehearsal Therapy worksheet targeting trauma-related nightmares. Client identified the recurring nightmare pattern, explored the emotional theme, created a safer alternative dream script, and practiced rehearsal with grounding support.

Safety Reminder

If rehearsal becomes too distressing, stop the exercise, use grounding, and return to the present environment. This worksheet should support stabilization and should not feel like forced trauma exposure.

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