Kristi Pruiksma, PhD is a clinical psychologist and researcher who develops treatments for sleep disorders, nightmares, and post-traumatic stress disorder, which are often — but not always — experienced together.
“Insomnia and nightmares are symptoms of PTSD,” she said, “but sometimes people who experience trauma may or may not have PTSD, but they have insomnia and nightmares.”
Up to 70% of people who have PTSD also have nightmares, according to Pruiksma, who is an associate professor in the Department of Psychiatry and Behavioral Sciences at UT Health San Antonio.
“They're having these dreams that are so disturbing that they're causing them to wake up, usually, and they can remember the dreams. They're very vivid. They're very disturbing,” Pruiksma explained.

Licensed clinical psychologist
Associate professor
Department of Psychiatry and Behavioral Sciences
The University of Texas Health Science Center at San Antonio
Pruiksma’s patients are mostly members of the military or veterans, and she uses a kind of talk therapy called cognitive behavioral therapy to help reduce the frequency and intensity of their nightmares. One technique involves a kind of exposure therapy, where the patient writes their nightmare down in as much detail as they can remember, then reads it aloud to their therapist.
“This is done in a very supportive, collaborative way, and it can be really difficult,” Pruiksma said, “but people also often feel very empowered after doing that.”
An alternative technique is called "rescripting."
“The idea is to write a new dream with a lot of detail and really change the scenario so that they have some power and control,” she said.
Pruiskma recalled a patient who had a terrifying recurring nightmare in which he was in a convoy that was driving down a road where a roadside bomb exploded. Pruiksma says he rewrote the dream to include one of his and his battle buddies’ favorite singers, Katy Perry.
“In his rescription, he had this Katy Perry angel coming in and distracting them, and then they go down a different road, and things happen a different way,” she said.
The idea, Pruiksma said, is to give the brain a different path to travel.
“People don't usually dream the rescription, but their dreams tend to change,” she said. “So either they don't wake up, or if they do wake up, it's not as disturbing, and they can go back to sleep faster.”
Pruiksma has created free, online training modules for practitioners who treat civilians experiencing nightmares. She is also developing a study that would examine a treatment for PTSD and nightmares that would, at the same time, also try to tackle insomnia that goes beyond nightmares.
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio that explores how scientific discovery in San Antonio advances the way medicine is practiced everywhere.