Cognitive Behavioral Therapy (CBT) for Nightmares in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans

This is a dismantling study with the objective of determining whether imagery rehearsal is
essential to the efficacy of imagery rehearsal + CBT-I for improving the sleep and nightmare
disturbance in Veterans with PTSD and recurrent nightmares.

Inclusion Criteria:

- Currently enrolled in treatment in the Michael J. Crescenz VA Medical Center or VA
Connecticut Healthcare System Mental Health Clinic

- Meets DSM-IV-R criteria for current PTSD (within the past month)

- Repetitive, military-related nightmares (at least 1 every 2 weeks, for at least 6
months)

- A global sleep disturbance, as indicated by a score of five or greater on the
Pittsburgh Sleep Quality Index

- Ability to read and speak English

- A concurrent anxiety disorder or depressive disorder diagnosis will be allowed

- Dementia related to head injury and amnestic disorder related to head injury will be
allowed

Exclusion Criteria:

- Current substance dependence

- Bipolar disorder

- Delirium

- Dementia that is not related to head injury

- Amnestic disorder that is not related to head injury

- Schizophrenia and other psychotic disorders

- Severe traumatic brain injury, as indicated by self-report (loss of consciousness or
alteration of mental status greater than 24 hours, or peri-traumatic memory loss, or
any posttraumatic amnesia greater than 7 days)

- The presence of diagnosed sleep disorders other than insomnia: narcolepsy, circadian
rhythm sleep disorders, and periodic limb movement disorder. Participants in treatment
for sleep apnea, or who have not benefited from or declined available treatment may be
included.