Predictors of treatment noninitiation, dropout, and response for cognitive behavioral therapy for trauma nightmares.
Katherine E Miller, Rachel L Micol, Joanne L. Davis, Christopher C Cranston, Kristi E. Pruiksma
Psychological Trauma: Theory, Research, Practice and Policy July 19, 2018 DOI: 10.1037/tra0000389 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 70 |
| Population | Trauma-exposed individuals with trauma nightmares |
| Topics | Dreaming |
| Keywords | Humans Treatment outcome Dreams Sleep Stress disorders, post-traumatic Implosive therapy Age factors Adult Patient dropouts Patient participation Female Cognitive behavioral therapy |
| Key findings | Younger age predicted treatment noninitiation or dropout in the exposure condition only, and fewer baseline nights with nightmares predicted it in both conditions; dropout alone had no significant predictors. Baseline severity on treatment-targeted constructs generally predicted the corresponding posttreatment outcomes, leading the authors to argue that treatment initiation is more significant than dropout and that reasons for noninitiation need study. |
Abstract
Objective: This report aims to extend previous findings on predictors of treatment dropout and response within nightmare treatment.
Method: Factors predicting treatment noninitiation, dropout, and response were examined in 70 trauma-exposed individuals treated in a randomized controlled trial of 2 conditions (exposure [EX] and nonexposure) of a therapy for trauma nightmares.
Results: Together, treatment noninitiation and dropout was predicted by younger age for the EX condition only and by fewer nights with nightmares at baseline for both conditions. Treatment noninitiation was predicted by fewer nights with nightmares. Treatment dropout was not predicted by any variables. For the EX condition, more baseline nightmares predicted more posttreatment nightmares, whereas more reported nights with nightmares at baseline predicted fewer nightmares at posttreatment. Baseline sleep quality and total posttraumatic stress disorder (PTSD) severity predicted posttreatment sleep quality and PTSD severity, respectively. In the nonexposure condition, more traumatic events predicted fewer nightmares at posttreatment, whereas more nightmares predicted more nightmares at posttreatment. Baseline daytime sleepiness predicted worse posttreatment sleep quality, and total PTSD symptom severity predicted posttreatment PTSD severity.
Conclusions: Baseline symptom severity on constructs targeted in treatment are the best indicators of response. Treatment initiation appears to be more significant than dropout. Identifying reasons for treatment noninitiation is needed to maximize engagement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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 |