RESUMO
BACKGROUND: In open and randomized controlled trials self-exposure therapy reduced the frequency of nightmares but follow-up ceased at 7 months post-entry. METHOD: Ten adults who attended an outpatient clinic and had DSM-IV nightmare disorder were put on a 3-month waiting-list. After 3 months they were given a self-exposure manual and were asked to follow its instructions for 4 weeks and were then followed up for 4 years. They were rated at 0, 3, 4, 5, 7, 10, 16, 28 and 52 months. At month 0 only, a matched control group of 10 subjects from the same clinic who had no axis I or II disorder was also rated. RESULTS: At month 0, the nightmare sufferers had more nightmares, anxiety, depression, hostility and somatic symptoms than the matched control group. All 10 nightmare sufferers completed the 3-month waiting-list, 4-week self-exposure therapy and 4-year follow-up without any dropouts. The recurrent nightmares and most associated symptoms did not improve while on the waiting-list but improved markedly after self-exposure therapy and remained improved over the 4-year follow-up. CONCLUSIONS: Adults' recurrent nightmares and associated symptoms failed to improve over a 3-month waiting-list period but reduced greatly after subsequent self-exposure therapy with minimal therapist contact over 1 month, and these gains continued over the next 4 years.