A pilot randomized controlled trial of cognitive behavioral treatment for trauma-related nightmares in active duty military personnel

Abstract

Study objectives: The aim of this study was to obtain preliminary data on the efficacy, credibility, and acceptability of Exposure, relaxation, and rescripting therapy for military service members and veterans (ERRT-M) in active duty military personnel with trauma-related nightmares.

Methods: Forty participants were randomized to either 5 sessions of ERRT-M or 5 weeks of minimal contact control (MCC) followed by ERRT-M. Assessments were completed at baseline, posttreatment/postcontrol, and 1-month follow-up.

Results: Differences between ERRT-M and control were generally medium in size for nightmare frequency (Cohen d = -0.53), nights with nightmares (d = -0.38), nightmare severity (d = -0.60), fear of sleep (d = -0.44), and symptoms of insomnia (d = -0.52), and depression (d = -0.51). In the 38 participants who received ERRT-M, there were statistically significant, medium-sized decreases in nightmare frequency (d = -0.52), nights with nightmares (d = -0.50), nightmare severity (d = -0.55), fear of sleep (d = -0.48), and symptoms of insomnia (d = -0.59), posttraumatic stress disorder (PTSD) (d = -0.58) and depression (d = -0.59) from baseline to 1-month follow-up. Participants generally endorsed medium to high ratings of treatment credibility and expectancy. The treatment dropout rate (17.5%) was comparable to rates observed for similar treatments in civilians.

Conclusions: ERRT-M produced medium effect-size reductions in nightmares and several secondary outcomes including PTSD, depression, and insomnia. Participants considered ERRT-M to be credible. An adequately powered randomized clinical trial is needed to confirm findings and to compare ERRT-M to an active treatment control.

Clinical trial registration: Registry: ClinicalTrials.gov; Title: A Pilot Randomized Controlled Trial of Treatment for Trauma-Related Nightmares In Active Duty Military Personnel; Identifier: NCT02506595; URL: https://ichgcp.net/clinical-trials-registry/NCT02506595.

Keywords: exposure; imagery rehearsal; nightmares; rescripting; trauma.

© 2020 American Academy of Sleep Medicine.

Figures

Figure 1. CONSORT chart showing participant flow through the randomized clinical trial.

Figure 2. Treatment credibility ratings.

Percent of participants endorsing low, medium, and high treatment credibility after session 1 and at 1-week posttreatment. Participants rated items on a scale from 1 “not at all credible” to 9 “very credible” following the first session of treatment and at 1-week posttreatment. Ratings are grouped into High (7–9), Medium (4–6), and Low (1–3) treatment credibility ratings.

Figure 3. Treatment expectancy ratings.

Percent of participants endorsing low, medium, and high treatment expectancy after session 1 and at 1-week posttreatment.