Pilot Study: Brief Posttrauma Nightmare Treatment for Persons With Bipolar Disorder

Abstract

Previous research on an efficacious cognitive-behavioral treatment for posttrauma nightmares and sleep disturbances (exposure, relaxation, and rescripting therapy; ERRT) has not tested the treatment in individuals with bipolar disorder. However, research suggests that individuals diagnosed with bipolar disorder are at increased risk for trauma exposure and development of posttrauma symptoms. The present pilot study sought to examine the acceptability and preliminary efficacy of a modified version of ERRT (ERRT-B) on reducing the frequency and severity of nightmares and improving sleep quality for 7 trauma-exposed individuals diagnosed with bipolar disorder who also reported frequent posttrauma nightmares (experienced on average for 16 years). Participants attended 5 weeks of ERRT-B and completed baseline, posttreatment, and 3-month follow-up assessments to measure changes in nightmare frequency, nightmare severity, and associated symptoms. Large effect sizes were observed for nightmare frequency, nightmare severity, and posttraumatic stress disorder symptoms, with 6 participants reporting zero nightmares at the 3-month follow-up assessment. Improvements in depression, global sleep quality, and insomnia severity were mixed. Results obtained from this study offer preliminary evidence in support of ERRT-B in reducing nightmare frequency and severity, and posttraumatic stress disorder symptoms. These results suggest clinical utility for the treatment of trauma-related nightmares in individuals with bipolar disorder and encourage more research.