Web-Based Provider Training for Cognitive Behavioral Therapy for Nightmares

Feb 24, 2022

An estimated 315,000 U.S. military service members experience chronic nightmares that only a handful of mental health providers know how to treat directly. People who suffer from nightmares report greater substance use, physical health problems, insomnia, and posttraumatic stress disorder (PTSD) symptoms, all of which can compromise military readiness and quality of life. They also are at increased risk for suicidal ideation, suicidal attempts, or suicide completion. If left untreated, nightmares can persist for decades.

While Cognitive Behavioral Therapy for Nightmares (CBT-N) is endorsed by the American Academy of Sleep Medicine as effective for treatment of nightmares related to trauma and PTSD, few providers know how to deliver these treatments, and training opportunities are rare. This is true for the Defense Health Agency, Veterans Health Administration, and in clinics that serve civilians.

CBT-N involves writing a different storyline for the nightmare and repeatedly imagining the new dream before sleep. This gives the mind a different path to follow during sleep. The therapy also can 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).

Training via: CBTNightmaresweb.org

A team led by Kristi Pruiksma, PhD, of The University of Texas Health Science Center at San Antonio aims to fill that gap by developing an online training program for CBT-N. This training via a site called CBTNightmaresweb would require less time and cost less than live workshops, while ensuring that providers receive state-of-the-science CBT-N training.

The team will work with leaders in the field, agencies, decision-makers and providers to develop and refine the program. They will then test it with a group of 100 providers who will complete either the CBTNightmaresweb training or a live workshop. The team then will compare the two groups’ reactions to and satisfaction with the training they received and will assess their learning via simulated treatment sessions.

The overarching goal of developing CBTNightmaresweb is to facilitate the delivery of nightmare treatment to improve the sleep and quality of life of service members, veterans, and civilians suffering from nightmares related to trauma. The U.S. military would benefit from improvements in the operational readiness and physical and mental health of its personnel.

Accelerating Implementation of Evidence-Based Psychotherapies in Military Settings

Feb 13, 2019

Although the U.S. military population experiences a high incidence of posttraumatic stress disorder (PTSD), evidence-based psychotherapies for PTSD remain difficult for service members to access.

The therapy for PTSD with the most scientific evidence supporting its use is Prolonged Exposure (PE), but numerous barriers often impair successful implementation of PE within the Military Health System (MHS). These barriers are complex and exist at multiple organizational levels, including at the provider level and within policies and guidelines of the MHS. Barriers to implementation of PE also may vary from one military treatment facility to another.

Investigators Craig Rosen, PhD, and Carmen McLean, PhD, with the Department of Veterans Affairs’ National Center for PTSD in Palo Alto, CA, and the Stanford University School of Medicine, are leading a STRONG STAR-affiliated study to address these barriers at eight military treatment facilities around the United States. The study team has developed a flexible implementation strategy, called Targeted Assessment and Context-Tailored Implementation of Change Strategies, or TACTICS, that is designed to improve the implementation of PE. In this research project, they will test the impact of TACTICS on the rate of PE use and patients’ PTSD treatment outcomes over and above standard provider training in PE.

At the individual military clinics participating in this study, the research team will work with clinical leadership and personnel to develop a tailored implementation plan for their unique clinic conditions. The TACTICS team will look at overall provider use of PE and patient treatment outcomes and will provide tools to boost implementation and performance.

The investigators hypothesize that accelerating the use of PE for PTSD within the MHS will increase the number of service members who can access and benefit from an effective treatment, enabling them to maintain or resume happy, productive lives in military careers, or as civilians. And as more patients recover, behavioral health clinics will have capacity to care for additional service members.

If TACTICS is effective in identifying solutions for the unique challenges of implementing PE, it could provide an intervention strategy for accelerating the use of other evidence-based treatments in military settings.

Implementation of Prolonged Exposure in the Army: Is consultation necessary for effective dissemination?

Aug 19, 2014

With the dramatic increase in the number of military service members identified with posttraumatic stress disorder (PTSD), one thing is clear: Military mental health providers need effective treatments at their disposal to help patients recover and regain their lives as soon as possible.

Research with civilians has shown Prolonged Exposure (PE) therapy to be highly effective, treating PTSD to the point of remission in approximately 80% of cases. While the Defense Department has made efforts to encourage military mental health providers to use PE and other evidence-based treatments, questions remain about dissemination methods: What is the best way to train providers so that they feel confident with evidence-based therapies and use them effectively in their practices? How can adequate training be provided most cost effectively to help the DoD stay within ever-tightening budget constraints?

Investigators affiliated with the STRONG STAR Consortium have designed a study to answer these important questions. Under the leadership of Dr. Edna Foa of the University of Pennsylvania, who developed PE, investigators are working with the Army to evaluate two different approaches to provider training.

Participating mental health providers at collaborating Army bases receive one of the following:

  • Standard PE Training, which involves an intensive four-day training workshop along with training materials and treatment manuals;
  • Extended PE Training, which includes the components of standard training plus in-depth consultation on two PE training cases via weekly telephone supervision by a PE expert.

Study investigators then evaluate the efficacy of the two training models by comparing provider attitudes toward the treatment, how frequently and effectively they use it, and how well their patients respond to the treatment.

Investigators hypothesize that Extended PE Training will improve both the frequency and efficacy of the therapy’s use by Army mental health providers. If that turns out to be the case, it could show that the added expense of extended provider training would result in the pay-off of improved patient care and higher rates of PTSD recovery among our service members.