Digital Cognitive Behavioral Therapy-Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial.
Fadia Isaac, Britt Klein, Huy Nguyen, Shaun Watson, Gerard A Kennedy
JMIR human factors March 14, 2025 DOI: 10.2196/65228 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pilot randomized controlled trial Pilot study Peer reviewed |
|---|---|
| Sample size | 30 |
| Population | Survivors of wildfires from Australia, Canada, and the United States, aged 18 to 79 years (mean 52.50, SD 16.26), 63% female, who met at least one threshold: Insomnia Severity Index score ≥8, Nightmare Disorder Index score ≥3, or PTSD Checklist for DSM-5 score ≥31 |
| Interventions | relaxation and rescripting therapy for nightmares |
| Duration | 4-week intervention, with assessments at baseline, posttreatment, and 3-month follow-up; waitlist group had an additional pretreatment assessment after 4 weeks of waiting |
| Measures | Insomnia Severity Index, Nightmare Disorder Index, PTSD Checklist for DSM-5, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index |
| Topics | PTSD Dreaming |
| Keywords | Cbti Errt Sleep best-i Bushfires Computer Digital health Ehealth Insomnia Mhealth Mobile health Nightmares Posttraumatic stress disorder Wildfires |
| Key findings | The digital intervention reduced nightmare severity by 1.64 points and PTSD symptoms by 10.64 points from baseline to posttreatment, with no significant change in insomnia symptoms. Secondary outcomes showed reduced sleep disturbance (2.22 points) and depressive symptoms (6.48 points), but no change in anxiety. The authors conclude the program reduced nightmares and trauma symptoms and recommend a larger definitive trial. |
Abstract
Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants' ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention's effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire-9. No changes were detected on the Generalized Anxiety Disorder-7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054.