An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults

An expert consensus panel reviewed treatment manuals for cognitive behavioral therapies for nightmares (CBT-N) tested in randomized clinical trials with adults. The panel developed guidelines for standardized implementation and terminology of CBT-N, addressing patient symptom presentations appropriate for treatment and components such as session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The recommendations aim to clarify confusion caused by unstandardized nomenclature and implementation nuances, and are intended to be revised as new research evidence emerges.

Study at a glance

Abstract

OBJECTIVES: Research supports cognitive behavioral therapies for nightmares (CBT-N) in adults. However, the nuances of implementation and unstandardized nomenclature for treatment components has created confusion in the field. To provide clarification, an expert consensus panel convened to review treatment manual components and to develop guidelines for the standardized implementation and terminology of CBT-N. The aims of this paper are to report on the expert panel recommendations. METHODS: A literature review was conducted for nightmare treatment manuals that have been tested in randomized clinical trials with adults. the panel of experts evaluated the content and the main controversies regarding treatment components. The panel then established recommended treatment guidelines based on the literature and clinical experience. RESULTS: Recommendations pertain to which patient symptom presentations are appropriate for CBT-N and considerations for implementing treatment components including session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The panel evaluated treatment components to inform the development of a consensus CBT-N treatment manual. CONCLUSIONS: Using a comprehensive treatment manual based on expert recommendations will not only help disseminate nightmare treatment but also advance the field by providing clarity. These recommendations are based on the status of the field and will need to be revised to incorporate developing research evidence in nightmare treatment.