Efficacy of a Brief Nightmare Treatment for Veterans

The purpose of the proposed pilot study is to extend previous findings regarding the impact
of a brief cognitive behavioral treatment for chronic nightmares by examining the emotional,
cognitive, behavioral, and health-related changes following treatment. Experiencing a
traumatic event may initiate or exacerbate the occurrence of nightmares. Indeed, sleep
disturbance, including nightmares, is considered a hallmark of posttraumatic stress disorder
(PTSD). Nightmares have been related to a variety of factors including stress, medications,
trauma, and substance use. Among veterans, especially combat veterans or those reporting
sexual assaults, symptoms of traumatic stress and nightmares are extremely common. Few
studies have investigated the efficacy of nightmare treatment in a veteran population, and
the impact of nightmare treatment on suicidal ideation has never been assessed.

Imagery Rehearsal Treatment (IRT) has received increased attention in the past decade for
use with chronic nightmares. Studies suggest that the treatment is promising for the
reduction of frequency and intensity of chronic nightmares in trauma exposed persons and may
have a generalized impact on symptoms of posttraumatic stress disorder and depression and
quality/quantity of sleep, although there is mixed evidence for sleep improvement among
veterans. The principal investigator has completed two randomized controlled trials of a
modified version of IRT, Exposure, Rescripting, and Relaxation Treatment (ERRT) and is
currently conducting a third randomized controlled trial (Davis, 2008; Davis & Wright,
2007). The current randomized controlled trial is comparing ERRT to an active treatment
(relaxation). Results demonstrated positive treatment response. Although these trials have
included some veteran participants, veterans have not been studied as a group using this
protocol. The purpose of this prospective study is to conduct a pre- and post-treatment
comparison of suicidal ideation and posttraumatic, depressive, and health symptoms in a
single group of veterans.