Like a reoccurring bad dream, the possessed doll Annabelle is back in theaters for the fourth time in four years. Introduced by producer James Wan after the success of his bloody, unsavory “Saw” movies, the not-quite-natural-looking doll’s frozen smile, staring eyes and tendency to attack people when the lights go out made her the breakout star of the films.

Still, none of those movies was as sinister as they hoped to be. Now “Annabelle: Creation” gives that sentient devil doll the eerie and unsettling prequel she deserves. The earlier films were never this deliciously twisted. Buckle up your belt or this moan-inducing, female-centric supernatural thriller will scare your pants off.

Director David F. Sandberg and writer Gary Dauberman understand that the best way to conjure audience anxiety is to cross different emotional states one step at a time. First, build a false calm by introducing good characters to care about. Move ahead to tension, creeping us out with hints that something, somewhere is stalking our on-screen surrogates. Then pick up the pace, shift into redline overdrive with a full-on barrage of gruesomeness, and hit the finish line at top speed.

The story unchains itself from its forerunners’ painfully bland narrative treadmill, stepping up to impressively creative territory. With echoes of “The Exorcist,” it introduces us to a solid American family to see them torn apart by tragedy beyond human control.

Anthony LaPaglia gives a no-foolishness performance as Samuel Mullins, a doll maker selling creations fashioned from ceramics, wood, hair and fabric. It’s a successful one-man business in the pre-Barbie 1940s, and he lives happily with his wife and 7-year-old daughter Bee in a substantial rural house. The Mullins are good, churchgoing folks, their faith underscored by the explicit and implied crucifixes seen throughout the film. But when a calamity strikes, their prayers for relief are answered in a way far from divine. If dolls can be made out of anything, they can be made into anything.

Years after that misfortune, Samuel and his wife open their large, lonely home to house six orphaned girls and their kindly supervising nun. The building is decrepit now, with floors that creak and one child’s room with a door frame marked with odd growth marks. That room is always kept locked, but little girls can be curious, even if it opens gateways they would never want to cross.

There’s a growing sense that it all could end badly. The many crosses begin to appear upside down or slanted sideways to resemble an X marking a doomed character for death. Calling the film’s impressively staged frights well-executed feels apt, especially as knives and hatchets come into play. The terrors unleashed on the troupe are so intense that I actually felt tempted to avert my eyes.

The entire cast has presence and depth, especially the young actresses who draw the most attention. I thought the youngest were the best of all. Talitha Bateman is heartbreaking as a sweet girl slowed by polio. And as her best friend, Lulu Wilson equals her outstanding work confronting possession and malevolent spirits in last year’s “Ouija: Origin of Evil.”

While hardly groundbreaking or inventive, this slick spook show works. It’s not a castoff collection of horror tropes but a surprisingly thoughtful, well-made and truly chilling nightmare. It employs fashionable scare tactics such as jump scares, but sparingly. It refines the basic components of the genre into a coherent film, then adds a layer of emotional gravitas and deals un-ironically with basic issues others ignore. How can a lightweight toy develop the momentum and power to violently attack a person? When the film exposes what’s hidden beneath that porcelain face, it’s extra bloodcurdling.

“Annabelle: Creation” is a refreshingly intelligent and taut shot in the arm for a genre that badly needs it.