A 31-year-old female patient with posttraumatic stress disorder (PTSD) takes prazosin (Minipress) for PTSD-associated nightmares. According to best practice guidelines, what nonpharmacologic treatment has the highest level of evidence for the treatment of nightmares in adults with PTSD?

Choice A reason: EMDR is effective for PTSD broadly but is not the first-line treatment specifically for nightmares. Choice B reason: Hypnosis has limited evidence and is not considered a first-line treatment for PTSD-related nightmares. Choice C reason: Progressive muscle relaxation may reduce general anxiety but has limited efficacy for nightmare-specific symptoms. Choice D reason: This is correct. Image rehearsal therapy has the highest level of evidence for reducing the frequency and intensity of PTSD-related nightmares. It involves rescripting the nightmare during wakefulness to alter its content and emotional impact.