Understanding Trauma Nightmares Using In-Home Measurement
Nightmares, Stress Disorders, Post-Traumatic, Actigraphy
About this trial
This is an interventional treatment trial for Nightmares focused on measuring Nightmares, Cognitive Behavioral Therapy, PTSD, Veterans
Eligibility Criteria
Inclusion Criteria:
- Be a Veteran enrolled to receive VA medical care at the Philadelphia VA
- Have stable housing for the duration of the study period
- Have experienced any traumatic event meeting Criterion A for PTSD at least three months before the baseline assessment
- Meet criteria for a current PTSD diagnosis
- Self-report experiencing trauma-related nightmares at least once per week for the past month, that are mostly-remembered and that cause awakening
- Self-report global sleep disturbance indicated by a score of 5 or greater on the Pittsburgh Sleep Quality Index (PSQI)
- Be stable on any psychoactive medications for a minimum of two weeks before the baseline assessment
Exclusion Criteria:
- Inability to provide fully-informed written consent to participate and/or a bed partner does not agree to mattress recording during the in-home portion of the study
Medical conditions that limit ability to apply the treatment
- e.g., needing a health aide or caregiver to record sleep diaries, unable to get out of bed without assistance
- Current pregnancy and/or birth of a child within the previous 6 months
- Apnea hypopnea index (AHI) > 15, indicative of moderate to severe sleep apnea, unless adherent to positive airway therapy following the baseline phase of the study
- Current alcohol or illicit substance use disorders or early remission (at least 3 months abstinent)
- Active suicidal or homicidal ideation
- A history of any bipolar disorder spectrum disorder or psychotic disorder
- Hospitalization for a mental health disorder in the past 2 months
- Enrolled in current PTSD-focused treatment (e.g., Cognitive Processing Therapy or Prolonged Exposure), current nightmare treatment or a history of treatment failure with a cognitive-behavioral nightmare intervention
- Veterans may also be excluded from participation if they have been identified by the local VA disruptive behavior committee to have displayed disruptive, threatening and/or violent behavior
Sites / Locations
- Minneapolis VA Health Care System, Minneapolis, MNRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Exposure, Relaxation, and Rescripting Therapy (ERRT)
Sleep and Nightmare Management
Exposure, Relaxation, & Rescripting Therapy (ERRT) will be conducted once a week for five consecutive weeks for approximately one hour per session. Each treatment session focuses on one of the following topics/skills: psycho-education and investment in treatment, sleep behavior modification, Progressive Muscle Relaxation, diaphragmatic breathing, exposure to the trauma-nightmare, rescription, and treatment maintenance planning.
This treatment protocol has amounts of therapist contact, handouts, and homework between sessions equivalent to those in ERRT. The protocol contains psychoeducation about sleep disturbances and trauma-related nightmares, including their distressing nature, chronicity, and impact on sleep and daytime functioning. Additionally, basic sleep behavior modification are presented. No nightmare content or rescripting will be explicitly discussed, and the diaphragmatic breathing techniques will be omitted from this protocol.