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

Pruiksma, K. E., Taylor, D. J., Mintz, J., Nicholson, K. L., Rodgers, M., Young-McCaughan, S., Hall-Clark, B. N., Fina, B. A., Dondanville, K. A., Cobos, B., Wardle-Pinkston, S., Litz, B. T., Roache, J. D., & Peterson, A. L., on behalf of the STRONG STAR Consortium.
Jan 15, 2020

Journal of Clinical Sleep Medicine, 16(1), 29-40. https://doi.org/10.5664/jcsm.8116


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..


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.


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.


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.