1200 Delivery of Cognitive Behavioral Therapy for Nightmares (CBT-N) in Primary Care Mental Health Integration Within the Veterans Health Administration

Abstract Introduction Nightmares are common, undertreated, and linked to various biopsychosocial issues in veterans. To address this clinical need, a provider training and consultation program in Cognitive Behavioral Therapy for Nightmares (CBT-N) was established in 2020 within the Veterans Health Administration (VHA). Program evaluation data indicate that clinicians perceive CBT-N to be beneficial, though they also note barriers to implementation, including the discordance between CBT-N and certain clinical settings. Primary Care Mental Health Integration (PCMHI) is one such setting where brief episodes of care may limit the feasibility of standard CBT-N protocols (e.g., six, one-hour sessions).

Methods: VHA clinicians who received training from CBT-N program experts, including those trained within the past six months, responded to survey outreach in May 2024 (n=65/100) and August 2025 (n=17/28). CBT-N benefits were rated on a 6-point scale. A subset of clinicians (n=15) completed the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure about the CBT-N treatments in which they were trained. Participants were also encouraged to provide free-text responses, which were reviewed and categorized. Analysis of variance compared scores between PCMHI clinicians and clinicians in other settings.

Results: Results found that PCMHI clinicians (n=13) perceived greater benefits of CBT-N than clinicians in other settings (n=64), yet they faced barriers to implementation like scheduling constraints. A sub-group analysis found that PCMHI clinicians (n=3), compared to clinicians in other settings (n=12), rated CBT-N to be just as acceptable for patients in their clinic (4.50[0.50] vs. 4.65[0.48]; p=.65), but significantly less appropriate for delivery in its current formats (4.00[0.43] vs. 4.73[0.45]; p=.02) and less feasible to deliver (3.00[0.00] vs. 3.69[0.43]; p=.02). The free-text responses suggested CBT-N is acceptable, increases access to care, and improves patient outcomes, yet remains discordant with the PCMHI model.

Conclusion: These findings are interpreted in light of the study’s limitations, such as a small sample size, multiple statistical comparisons, and the cross-sectional design. Nevertheless, these preliminary findings suggest a need to adapt CBT-N for PCMHI. Doing so could expand access to nightmare treatment within the VHA and benefit veterans’ mental health. Support (if any) AASM Foundation 346-SR-24 (KEM)