Web-Based Provider Training for Cognitive Behavioral Therapy for Nightmares (CBT-N)
Abstract
This proposal addresses the FY20 Topic Area of Sleep Disorders and Restriction and the specific priority of “Research on the precision diagnosis and/or treatment of sleep disorders, especially…related to post-traumatic stress disorder (PTSD)” by developing and disseminating a web-based platform for training providers in precision diagnosis of and evidence-based cognitive behavioral therapy for nightmares (CBTn) related to PTSD. Critical Problem to Be Addressed: Debilitating nightmares are commonly experienced by military personnel following traumatic experiences that involve actual or threatened death, serious injury, or sexual violence (e.g., combat, sexual assault, death of a friend by suicide, training accidents, etc.). Nightmares are intense, realistic, terrifying dreams that elicit awakenings, sometimes with intense physiological arousal such as racing heart, sweats, and rapid breathing. Nightmares typically replay some or all aspects of horrific events and evoke guilt, anger, fear, or helplessness similar to that experienced during the trauma. It can often take hours to fall back to sleep following a nightmare. Not surprisingly, people who suffer from nightmares also report greater substance use, physical health problems, insomnia, and PTSD symptoms, all of which can compromise military readiness and quality of life. People who suffer from nightmares are also at increased risk for suicidal ideation, suicidal attempts, or suicide completion. If left untreated, nightmares can persist for decades. I have anywhere from one to three nightmares every night. They wake me up almost every time, and it takes so long to fall back asleep. Sometimes I don t even try. Sometimes the dreams are so bad I wake up and vomit. I m so tired during the day, but when it s time to go to sleep, I try to keep myself awake because I know I m just going to have more nightmares. I might drink to knock myself out, but it doesn t keep the nightmares away. Sometimes I wish I was dead so I didn t have to relive this every night. – 28-year-old male, SGT, U.S. Army. Many patients receive a medication called prazosin (or minipress), which was originally “recommended” by the American Academy of Sleep Medicine but has since been downgraded to “may be used” based on a large study that found prazosin to be ineffective in military Veterans with PTSD and recurrent nightmares. Many patients, particularly active-duty Service Members, prefer not to take medication. However, cognitive behavioral therapies for nightmares (CBTn) are endorsed by the American Academy of Sleep Medicine as effective for the treatment of nightmares related to trauma and PTSD. CBTn reduces nightmare frequency and severity and improves sleep and symptoms of depression and PTSD. Briefly, CBTn involves writing a different storyline for the nightmare (i.e., rescripting) and repeatedly imagining the new dream before sleep. This gives the mind a different path to follow during sleep. Many CBTn protocols also include education about sleep and trauma, identifying and modifying unhelpful sleep habits, relaxation training, and written exposure therapy to nightmare content (similar to treatments for PTSD). Unfortunately, there is a lack of providers trained in CBTn throughout the Defense Health Agency, Veterans Health Administration, and civilian community and very limited training opportunities. The proposed development of a web-based provider training for CBTn would fill this gap with less financial and time costs compared to live workshops and would also ensure providers receive state-of-the science CBTn training. Overview of the Project: The objective of the proposed project is to develop and evaluate a web-based training program for CBTn building upon our experience developing other, successful web-based trainings for insomnia and PTSD. The web-based training, CBTnweb, will be fully sustainable and accessible with minimal costs and time constraints for providers. CBTnweb will be bu
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110576
Entities
People
- Kristi E Pruiksma
Organizations
- United States Army
- University of Texas Health Science Center at San Antonio