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APRIL 2012
Case Report
Psychotherapeutic Management of
Night-time Fears
S. Malhotra1, G. Rajender2, M.S. Bhatia3
Department of Clinical Psychology, CNBC Hospital & MAMC, Delhi,
2
Department of Psychiatry, Mahatma Gandhi Medical College, Jaipur,
3
Department of Psychiatry, UCMS & GTB Hospital, Delhi
1
Introduction
Nightmares and fear of sleeping alone are
common in children but may become developmentally inappropriate and more problematic,
warranting clinical intervention. Behavioural
approaches such as the operant reinforcement of
appropriate nighttime behaviour and not reinforcing
anxious/ avoidant behaviours have been shown to
be effective in such cases1. Nocturnal anxiety in
children has also been managed through cognitive
behavioural programmes that combine exposure,
cognitive restructuring, relaxation and incentive
programmes2. Yet another technique that has been
reported to be effective in the treatment of childhood
phobias is emotive imagery3 and refers to imagery
that produces positive feelings (for example, selfassertion, pride, affection) and other similar anxiety
inhibiting responses. It is considered to be a form
of systematic desensitization because the child
engages in emotive imagery while anxiety
provoking items are gradually introduced. This
typically involves the therapist helping the child to
develop a story about the childs favourite heroes
helping them to be brave or fight back when the
feared object is presented 4 . The child may be
encouraged to pretend to be some hero and take on
their characteristics (for example, courage or special
powers). Emotive imagery has been specifically
recommended for managing nighttime fears.5,6 It has
been assumed that emotive imagery may be
particularly useful in treating anxiety where the
phobic object is imaginary, such as monsters and
ghosts and conventional invivo exposure is not
possible7 .
The present case study highlights the process
of psychotherapy for a six year old boy reporting
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