Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans
Rachel M. Ranney, R. Gloria, Thomas J. Metzler, Joy Huggins, Thomas C. Neylan, Shira Maguen
Journal of Clinical Sleep Medicine April 11, 2022 DOI: 10.5664/jcsm.10002 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 91 |
| Population | Military veterans with insomnia disorder |
| Interventions | Brief behavioral treatment for insomnia Progressive muscle relaxation therapy |
| Duration | 4 sessions (intervention), 6-month follow-up |
| Topics | Dreaming |
| Registration | NCT02571452 |
| Key findings | BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, but reductions were not maintained at 6-month follow-up. |
Abstract
Trauma-related nightmares are highly prevalent among veterans and are associated with higher-severity insomnia and posttraumatic stress disorder. Cognitive behavioral therapy for insomnia (typically 6–8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and nontrauma-related bad dreams using an active control group treated using progressive muscle relaxation therapy. In addition, we tested whether baseline trauma-related nightmare frequency and baseline nontrauma-related bad dream frequency moderated changes in insomnia severity. Participants were 91 military veterans with insomnia disorder randomized to BBTI or progressive muscle relaxation therapy. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and nontrauma-related bad dream frequency on the Pittsburgh Sleep Quality Index–PTSD Addendum. We found that BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, whereas progressive muscle relaxation therapy did not. However, reductions in trauma-related nightmares were not maintained at the 6-month follow up. Neither BBTI nor progressive muscle relaxation therapy reduced nontrauma-related bad dreams from baseline to posttreatment. We also found that neither baseline trauma-related nightmare frequency nor baseline nontrauma-related bad dream frequency moderated changes in insomnia symptom severity. Findings from the current study suggest that BBTI may help reduce trauma-related nightmares. Further research is needed to better understand the potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); URL: https://clinicaltrials.gov/ct2/show/NCT02571452; Identifier: NCT02571452. Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med. 2022:18(7):1831–1839.
Comparable studies
Other randomized controlled trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Combat veterans of Operation Enduring Freedom and/or Operation Iraqi Freedom (mean age... | 2013 | Randomized controlled trial | n = 40 |
| Lucid Dreaming Treatment for Nightmares: A Pilot Study Chronic nightmare sufferers | 2006 | Randomized controlled trial | n = 23 |
| Testing the involvement of the prefrontal cortex in lucid dreaming: A tDCS study Participants spending three consecutive nights in a sleep laboratory | 2013 | Randomized controlled trial | n = 19 |
| Pre-sleep treatment with galantamine stimulates lucid dreaming: A double-blind, placebo-controlled, crossover study Adults with high dream recall and an interest in lucid dreaming | 2018 | Randomized crossover trial | n = 121 |
| Studies with lucid dreaming as add-on therapy to Gestalt therapy Adults with nightmares (ICD-10: F51.5) at least twice a week | 2015 | Randomized controlled trial | n = 32 |
Citations in the library
Cited by 3
- Interventions for Trauma-Related Nightmare: Where Are We Now? The International Journal of Neuropsychopharmacology May 24, 2023
- Status of Imagery Rehearsal Therapy and Other Interventions for Nightmare Treatment in PTSD. Current Psychiatry Reports November 1, 2025
- Endorsement of: "Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper" by the World Sleep Society. Sleep Medicine January 2, 2025
Cites 5
- Assessing Triggers of Posttrauma Nightmares. Journal of Traumatic Stress June 10, 2020
- The impact of prolonged exposure on sleep and enhancing treatment outcomes with evidence-based sleep interventions: A pilot study. Psychological Trauma: Theory, Research, Practice and Policy February 1, 2020
- Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans. Journal of Clinical Sleep Medicine May 15, 2019
- Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial Journal of Traumatic Stress October 1, 2010
- Variety and intensity of emotions in nightmares and bad dreams. The Journal of Nervous and Mental Disease April 1, 2006