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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion r eGulation Handout 20a  (Emotion Regulation Worksheet 14a)
nightmare p rotocol, Step by Step
When  Nightmares Keep You from Sleeping
1. practice relaxation, pleasant imagery, and coping skills first, to be sure 
you are ready to work on changing your nightmares.
Do progressive relaxation, paced breathing, and/or Wise Mind exercises; 
listen to music or guided imagery; review the distress tolerance crisis survival skills.
2. choose a recurring nightmare you would like to work on.
This will be your target nightmare. Select a nightmare you can manage now. 
Put off trauma nightmares until you are ready to work with them—or, if you 
target a trauma nightmare, skip Step 3.
3. Write down your target nightmare.
Include sensory descriptions (sights, smells, sounds, tastes, etc.). Also 
include any thoughts, feelings, and assumptions about yourself during the 
dream.
4. choose a changed outcome for the nightmare.
The change should occur BEFORE  anything traumatic or bad happens to you 
or others in the nightmare. Essentially, you want to come up with a change that will prevent the bad outcome of the usual nightmare from occurring. Write an ending that will give you a sense of peace when you wake up.
Note: Changes in the nightmare can be very unusual and out of the ordinary 
(e.g., you might become a person with superhuman powers who is able 
to escape to safety or fight off attackers). Changed outcomes can include changed thoughts, feelings, or assumptions about yourself.