The Development and Evaluation of a Web-Based Training Program for Cognitive Behavioral Therapy for Nightmares: CBTNightmares.org.
Kristi E. Pruiksma, Joanne L. Davis, Jessica R. Dietch, Daniel J. Taylor, Tao Lin, Rebecca Campbell, Hannah Tyler, William Price, Ethan Olson, Sophie Wardle‐Pinkston, Stacey Young-McCaughan, Alan L Peterson, Courtney J Bolstad, Stefanie T LoSavio, Allison K. Wilkerson
Military Medicine January 1, 2026 DOI: 10.1093/milmed/usaf385 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized comparison study (with preceding alpha and beta testing phases) Peer reviewed |
|---|---|
| Sample size | 114 |
| Population | Licensed behavioral health providers (comparison phase); earlier phases included licensed providers and trainees |
| Topics | Dreaming |
| Key points | In the randomized comparison, posttest knowledge scores were about 8% higher for CBTNightmares.org than for the live-virtual workshop (86% vs. 78%), meeting the 10-percentage-point non-inferiority criterion and outperforming the workshop. Fidelity ratings for core CBT-N components did not differ significantly by training condition (Wilks' Lambda = 0.78, F(11, 60) = 1.53, P = .144). |
Abstract
Chronic nightmares are associated with a range of mental and physical health problems, including posttraumatic stress disorder, depression, alcohol use, and suicide risk. Cognitive behavioral therapy for nightmares (CBT-N) is a recommended treatment, but is underutilized because of the lack of providers trained in CBT-N. We developed and evaluated a web-based provider training for CBT-N: CBTNightmares.org. Experts developed the content and a prototype of CBTNightmares.org. Testing occurred in 3 phases. First, licensed behavioral health providers and trainees with and without a background in CBT-N (n = 17) completed alpha testing, including pre- and post-module quizzes, evaluation questionnaires, and individual interviews. The feedback was used to refine CBTNightmares.org. Next, licensed behavioral health providers and trainees (n = 47) without CBT-N training completed beta testing, including pre- and post-module quizzes and evaluation questionnaires. This informed a second round of revisions to the web-based training. Finally, licensed behavioral health providers were randomly assigned to complete either CBTNightmares.org (n = 57) or a live-virtual 1-day workshop (n = 57). Both groups completed knowledge assessments and a mock therapy session in which they implemented core components of CBT-N (i.e., assessment, exposure-related activities, and rescription-related activities) with a standardized patient and were rated for fidelity to each component of the CBT-N consensus manual. Alpha and beta testing provided valuable feedback used to improve the site. In the comparison study, estimated marginal posttest mean scores were 8% better in CBTNightmares.org (i.e., CBTNightmares.org = 86% vs. CBT-N live-virtual workshop = 78%), indicating that CBTNightmares.org not only met the non-inferiority criterion set at 10 percentage points, but outperformed CBT-N live-virtual workshop. For fidelity ratings, training condition did not have a statistically significant multivariate effect (Wilks' Λ = 0.78, F(11, 60) = 1.53, P = .144). Web-based provider training for CBT-N, CBTNightmares.org, was comparable to a live-virtual workshop and effectively equipped providers with knowledge and skills in assessing and treating nightmares. With its user-friendly access to multimedia resources and its affordability, CBTNightmares.org is poised to promote wide dissemination of training in the delivery of CBT-N and thereby improve the treatment of nightmares in military, veteran, and civilian populations.
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 |
| The Beneficial Effects of One Treatment Session and Recording of Nightmares on Chronic Nightmare Sufferers Adults with chronic nightmares (mean duration 17.2 years) | 1992 | Randomized controlled trial | n = 20 |
| 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 |
Citations in the library
Cites 10
- Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Sleep June 1, 2010
- An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults Behavioral Sleep Medicine January 15, 2025
- Nightmare frequency is a risk factor for suicidal ideation during the COVID-19 pandemic. Journal of Sleep Research October 1, 2024
- Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clinical Psychology Review December 17, 2022
- Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews April 1, 2020
and 5 more in the library