Providers' use and perceived benefits and barriers of delivering cognitive behavioral therapy for nightmares (CBT-N) to veterans.
Psychological Services September 15, 2025 DOI: 10.1037/ser0000994 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Survey study Peer reviewed |
|---|---|
| Sample size | 100 |
| Population | Veterans Health Administration providers who completed CBT-N training at least 6 months earlier |
| Intervention | Cognitive behavioral therapy for nightmares (CBT-N) |
| Topics | Dreaming |
| Key findings | Among 65 survey responders, 95% of providers reported continued delivery of CBT-N and 100% intended future use; users perceived reduced nightmare frequency and/or severity and improved sleep health, trauma symptoms, and quality of life. About one-third reported no barriers, with the main barriers being facility inner-setting constraints and veteran factors such as scheduling and shared decision-making. |
Abstract
Training and consultation in cognitive behavioral therapy for nightmares (CBT-N) were introduced for Veterans Health Administration (VHA) providers to reduce the frequency and severity of nightmares and improve functioning of veterans experiencing chronic nightmares. This study aimed to evaluate providers' sustained delivery of CBT-N and their perceptions of benefits and barriers to implementation to improve the successful adoption and long-term use of CBT-N throughout the VHA. VHA providers (N = 100) who completed the CBT-N training program at least 6 months prior to the study were sent an online survey about their continued use, feedback, and perceptions of CBT-N. The survey received a 65% response rate. Overall, perceptions of CBT-N were favorable. Ninety-five percent of providers reported continued delivery of CBT-N since completing the training program, with 100% of responders intending to use CBT-N in the future. Among CBT-N users, treatment was perceived to reduce nightmare frequency and/or severity and improve other domains of functioning (i.e., sleep health, trauma symptoms, quality of life). A third of the CBT-N users denied any barriers to using CBT-N. Primary barriers to use were related to providers' facility inner setting (e.g., unable to accommodate required session length or frequency, veteran population not appropriate for CBT-N) or veteran factors (e.g., schedule constraints, patient decision in shared decision making). Results encourage ongoing CBT-N training initiatives within the VHA. Directly tracking veteran outcomes and identifying necessary modifications to adapt CBT-N within the constraints of the inner setting, while preserving treatment integrity, are warranted to ensure and promote intervention effectiveness. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
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 |