A pilot randomized controlled trial of cognitive behavioral treatment for trauma-related nightmares in active duty military personnel

Study Objectives: The aim of this study was to obtain preliminary data on the efficacy, credibility, and acceptability of Exposure, relaxation, and rescripting therapy for military service members and veterans (ERRT-M) in active duty military personnel with trauma-related nightmares. Methods: Forty participants were randomized to either 5 sessions of ERRT-M or 5 weeks of minimal contact control (MCC) followed by ERRT-M. Assessments were completed at baseline, posttreatment/postcontrol, and 1-month follow-up. Results: Differences between ERRT-M and control were generally medium in size for nightmare frequency (Cohen d = −0.53), nights with nightmares (d = −0.38), nightmare severity (d = −0.60), fear of sleep (d = −0.44), and symptoms of insomnia (d = −0.52), and depression (d = −0.51). In the 38 participants who received ERRT-M, there were statistically significant, medium-sized decreases in nightmare frequency (d = −0.52), nights with nightmares (d = −0.50), nightmare severity (d = −0.55), fear of sleep (d = −0.48), and symptoms of insomnia (d = −0.59), posttraumatic stress disorder (PTSD) (d = −0.58) and depression (d = −0.59) from baseline to 1-month follow-up. Participants generally endorsed medium to high ratings of treatment credibility and expectancy. The treatment dropout rate (17.5%) was comparable to rates observed for similar treatments in civilians. Conclusions: ERRT-M produced medium effect-size reductions in nightmares and several secondary outcomes including PTSD, depression, and insomnia. Participants considered ERRT-M to be credible. An adequately powered randomized clinical trial is needed to confirm findings and to compare ERRT-M to an active treatment control. Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: A Pilot Randomized Controlled Trial of Treatment for Trauma-Related Nightmares In Active Duty Military Personnel; Identifier: NCT02506595; URL: https://clinicaltrials.gov/ct2/show/NCT02506595.