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Delivering Cognitive Behavioral Therapy for Nightmares (CBT-N) in primary care within the Veterans Health Administration: A preliminary report on clinician-perceived barriers and benefits.

Courtney J Bolstad, Constance H Fung, Lori L. Davis, Lisa Zubkoff, Adam D Bramoweth, Audrey L Austin, Gerald McGwin, Christina Krieg, Katherine E Miller

Journal of Clinical Sleep Medicine May 22, 2026 DOI: 10.1007/s44470-026-00073-z (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Program evaluation with survey and subanalysis Peer reviewed
Sample size 77
Population Mental health clinicians in the Veterans Health Administration, including Primary Care Mental Health Integration (PCMHI) clinicians and clinicians in other settings
Intervention Cognitive Behavioral Therapy for Nightmares (CBT-N)
Topics Dreaming
Keywords Humans Dreams Veterans Primary health care United states Female Cognitive behavioral therapy Implementation science Healthcare services Imagery rehearsal therapy
Key findings PCMHI clinicians perceived greater benefits of CBT-N than clinicians in other settings but reported barriers such as scheduling constraints; a small subanalysis found PCMHI clinicians rated CBT-N as significantly less appropriate and feasible. The authors argue these preliminary findings support adapting CBT-N for PCMHI to improve uptake and access to nightmare treatment.

Abstract

Nightmares, which are associated with various biopsychosocial issues, are common and often undertreated among veterans. To address the demand for Cognitive Behavioral Therapy for Nightmares (CBT-N) in the Veterans Health Administration (VHA), experts have trained mental health clinicians in its delivery. Program evaluation data show positive clinician perceptions of CBT-N but reveal implementation barriers, including the incompatibility between CBT-N and certain practice settings. One such setting is Primary Care Mental Health Integration (PCMHI), where brief episodes of care may limit CBT-N feasibility. Survey results suggest PCMHI clinicians (n=13) perceive greater CBT-N benefits than clinicians in other settings (n=64) but face barriers such as scheduling constraints. A subanalysis showed that PCMHI clinicians (n=3) find CBT-N to be significantly less appropriate and feasible than clinicians in other settings (n=12). These preliminary findings support adapting CBT-N for PCMHI as a pathway to increased uptake and improved access to nightmare treatment within the VHA.

Comparable studies

Other cross-sectional and survey studies on dreaming, most cited first.

Study Year Design Participants
Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Undergraduate students at a large, public university in the southeastern United States 2011 Observational cross-sectional survey n = 583
Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Middle-aged Hong Kong Chinese adults from the community, mean age 40.9 years (SD 5.5,... 2010 Cross-sectional survey with subsequent clinical evaluation (two-phase design) n = 8,558
Factors of home dream recall: a structural equation model Adults (general population sample) 2003 Cross-sectional survey with structural equation modeling n = 444
The Phenomenology of Lucid Dreaming: An Online Survey Respondents to an online survey about lucid dreams 2014 Online survey n = 684
Frequency of Lucid Dreaming in a Representative German Sample Representative sample of German adults 2011 Cross-sectional survey n = 919

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