Table 1 Summary of RCTs examining psychosocial treatments of nightmares
From: Psychosocial treatments for nightmares in adults and children: a systematic review
Author | Country | Participants/ Sex/ N = female | Mean Age | Population | Intervention | Control | Sessions | Mode | Outcome measures | % Attrition | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|
Belleville et al [34] | Can | 42 (37 F) | 30 | Civ PTSD | CBT + IRT | Active (CBT) | 5 × 60 min | Ind | NDQ: DI, NNN | 7 | CBT and CBT + IRT sig decreased NM symptoms (DI but not NNN). Adding IRT early sig better than CBT alone. No F/U |
Casement et al [35] | USA | 45 (0 F) | Â | Civ PTSD | NET | Passive(waitlist) | 6Â weeks | Ind | NN | Â | NET sig reduced NN (vs control) post-treatment. Maintained at 3Â m F/U |
Cook et al [36] | USA | 124 (0 F) | 59 | Mil PTSD | IRT | Active (sleep & NM Man) | 6 × 90 min | Group | NFQ: NN, NNN NES: DI | 10.5 | No sig effects including 6 m F/U |
Davis et al [37] | USA | 47 (35 F) | 47 | Civ PTSD | ERRT | Passive (waitlist) | 3 × 120 min | Ind Group | TRNS: NN, NNN, IN | 25.5 | Sig improvements found for NN, NNN & IN at 1w post-test and at 6 m F/U |
Davis & Wright [38] | USA | 49 (40 F) | 40 | Civ PTSD | ERRT | Passive (waitlist) | 3 × 120 min | Ind Group | TRNS: NN, NNN, IN | 25.6 | 84% reported absence of NM in previous week at 6 m F/U. Most effective on IN |
Forbes et al [39] | AUS | 12 (0 F) | 48 | Mil PTSD | IRT | No control | 6 × 90 min | Group | NN, NNN, IN | 0 | NN, NNN, IN improved sig (vs control) post treatment, and at 3 m & 12 m F/U |
Germain et al [40] | USA | 57 (12 F) | 41 | Mil PTSD | BSI (IRT & stimulus control/sleep restriction) | Active (Prazosin) or placebo | 8 × 45 min | Ind | NNN | 28 | Sig reduction in NNN in both groups compared to control. CBT & Prazosin had an equivalent effect. No F/U |
Gieselmann et al [41] | Germany | 127 (109 F) | 36 | Civ Ideopath | IRT guided or IRT unguided | Active (frequency or narrative control) | 6 sessions | Ind | NDQ: DI NN | 28 | Both guided & unguided better than controls for reducing NN & DI, except for NN for narrative control group. Effects held at F/U except narrative control group |
Gray et al [42] | USA | 74 (0 F) | 49 | Mil PTSD | RTM | Passive (waitlist) | 3 × 120 min | Self-help | PSS-I: NN, DI | 42 | Sig reductions compared to control at post-test & 6w F/U |
Gutner et al [43] | USA | 171 (171 F) | 32 | Civ PTSD | CPT or PE | Passive (waitlist) | 12 sessions | Group | NN, IN | 29.2 | Both CPT & PE significantly reduced NN & IN compared to waitlist, including 9Â m & long-term F/U. No remission |
Harb et al [44] | USA | 108 (15 F) | 37 | Mil PTSD | IRT + CBT-I | Active (CBT-I) | 6 × 60 min | Ind | NDQ: DI NFQ: NN NFQ: NN, NNN | 28 | Both groups showed 29% reduction in NN, NNN, with 22% remission. Combined therapy not better than CBT-I alone. No F/U |
Holzinger et al [45] | Aus | 40 (24 F) | 35 | Mil | Gestalt + LDT | Active (Geastalt) | 9 × 90 min | Group | NN, NNN | 20 | Sig reduction of NM frequency was found in both groups after the 10w study & at F/U |
Krakow et al [33] | USA | 30 (30 F) | 15.6 | Civ PTSD | IRT | Passive (waitlist) | 1 × 6 h day workshop | Group | NN, NNN | 33 | At 3 m, S-Rep, retrospectively assessed NNN sig decreased 57% with large effect size + NN sig decreased 71% with large effect size in the treatment group. No sig changes in the control group |
Krakow et al [46] | USA | 168 (168 F) | 36 | Civ PTSD | IRT | Passive | 2 × 180 min + 1 × 60 min | Group | NFQ: NN, NNN NDQ: DI | 40.5 | Treatment sig reduced NN & NNN at post-test & 6 m F/U compared to control (moderate effect compared to small) |
Kunze et al [47] | Neth | 104 (80 F) | 35 | Civ Ideopath | IR IE | Passive (waitlist) | 3 × 60 min | Ind | NN, NNN, DI | 11.5 | Compared to control, both groups sig reduced NN, NNN, & DI. Maintained at 6 m F/U. No diff between IR and IE. Effects mediated by increased mastery |
Lancee et al [48] | Neth | 70 (67 F) | 30 | Civ Ideopath | IRT | Passive (waitlist) | 3 sessions | Guided self-help | SLEEP-50: DI, NN, NNN | 17.1 | Compared to controls IRT sig reduced NN, NNN, and DI, including 3 and 6Â m F/U. Effects mediated by increased mastery |
Lancee et al [49] | Neth | 198 (159 F) | 39 | Civ | IRT or PE | None | 6Â weeks | Guided self-help | SLEEP-50: DI, NN, NNN | 0 | NN, NNN, DI had moderate effect sizes on both treatment conditions. No diff between conditions. Effects sustained at 42w F/U |
Lancee et al [50] | Neth | 278 (212 F) | 36 | Civ | IRT IRT +  LDT + IRT | Passive (waitlist) | 6 weeks | Guided self-help | SLEEP-50: DI, NN, NNN | 45.7 | Only IRT sig better than control. IRT better than IRT + and LDT + IRT. Consistent at 42w F/U, but high attrition |
Lancee et al [51] | Neth | 399 (307 F) | 39 | Civ | IRT or PE or Recording | Passive (waitlist) | 6Â weeks | Guided self-help | SLEEP-50: NN, NNN, DI | 29.3 | IRT & PE sig better than Recording in reducing DI, NN, and NNN. IRT best for NN, NNN, & PE best for reducing DI. Recording better than control. No F/U |
Larsen et al [52] | USA | 108 (108 F) | 32 | Civ PTSD | CPT or PE | None | - | Ind | NN, NNN, IN | Â | Both CPT & PE sig reduced symptoms. No F/U. Guilt was the prevailing residual symptom |
Margolies et al [53] | USA | 40 (4 F) | 38 | Mil PTSD | CBT-I + IRT | Passive (waitlist) | 4 × 60 min | Ind | NN, NNN, IN | 25 | Sig reduction in NN, NNN, IN compared to control. No F/U, high attrition |
Pruiksma et al [54] | USA | 70 (50 F) | 43 | Civ Ideopath | ERRT + Exposure and Rescripting | Active (ERRT w/o Exposure & Rescripiting) | 3 × 90 | Ind | NN, NNN, DI | - | Both groups showed medium to large effect size improvements in NN, NNN, DI. Conditions did not differ at any time point. Exposure and Rescripting did not add sig benefit. Benefits maintained at 6 m F/U |
Pruiksma et al [55] | USA | 40 (0 F) | 33 | Mil PTSD | ERRT-M | Active (MCC followed by EERT-M) | 5 sessions or 5Â weeks of control | Ind | NN, NNN, IN | Â | Medium effect size reductions in NN, NNN, and IN. ERRT sig better than control at post-treatment & 1Â m F/U |
Rhudy et al [56] | USA | 40 (29 F) | 38 | Civ PTSD | ERRT | Passive (Waitlist) | 3 × 120 min (2 h per week) | Ind | Physical & emotional reactions | 22.5 | Treatment reduced physiological & subjective reactions to NM imagery compared to controls at post & 3 m F/U |
Sheaves et al [57] | UK | 24 (10 F) | 41 | Civ Psychosis | CBT + IRT | Active (IRT) | 4 × 60 min | Ind | IN, NN, DI | 0 | NM specific CBT + IRT led to large improvements in NM compared to IRT alone. Gains maintained at 4w F/U compared to IRT alone |
Spoormaker & van den Bout [58] | Neth | 23 (17 F) | 28 | Civ PTSD | LDT 2 h (Individual) LDT 2 h (Group) | Passive (Waitlist) | 1 × 120 min | Ind/Group | SLEEP-50: NN, IN | 0 | At 12w F/U, LDT groups sig reduced NN. Reductions also occurred in control |
St-Onge et al [32] | Can | 20 (9 F) | 10 | Civ Ideopath (Children) | IRT | Passive (Waitlist) | 3 meetings | Self-Help | S-Rep, NDQ: NN, DI | 0 | IRT reduced NN compared to control including 9Â m F/U. Pts had low numbers & IN at baseline |
Swanson et al [59] | USA | 10 (0 F) | 59 | Mil PTSD | CBT-I + ERRT | No control | 10 × 90 min | Group | Diary—IN NN | 20 | Pts reported an average 50 % decrease in NN per week over 10w & large effect in reducing IN |
Talbot et al [60] | USA | 45 (31 F) | 37 | Civ PTSD | CBT-I | Passive (waitlist) | 8 sessions (8Â weeks) | Ind | IN, NN | 26 | CBT- I sig reduced NN & IN including 6Â m F/U. Unclear evidence as to whether the effect was greater than control |
Taylor et al [61] | USA | 128 (19 F) | 34 | Mil PTSD | PE (Spaced) | Active PCT + PE (Massed) | 10 sessions (2 or 8 weeks) | Ind | IN, NNN |  | Sig reduction in IN for the spaced group but not the massed group. Unclear comparisons to PCT |
Thünker & Pietrowsky [62] | Germany | 69 (47 F) | 38 | Civ Mixed | IRT | Passive) | 8 × 50 min (10 weeks) | Ind | NN (Unknown Scale) | 17 2 | NN sig reduced over time including F/U, but effect was not greater than control |
Ulmer et al [63] | USA | 22 (7 F) | 46 | Mil PTSD | CBT + IRT | Passive Active | 6 × 60 min (12 weeks) | Ind | S-Rep, NN | 18.2 | Medium to large effect reduction in NN for experimental group. 33% remission rate |
Neth | 90 (72 F) | 36 | Civ Psychiatric | IRT | Passive Active | 6 sessions (added to treatment as usual) | Ind | NFQ, NDQ, NES: NN, NNN, DI | Â | Moderate effect reductions in NN, NNN & DI for the IRT group compared to control, held at 3, 6- and 9Â m F/U | |
Walters et al [66] | Aus | 55 (0 F) | 35 | Mil PTSD | PE + IRT + CBT-I | Active PE + SCT | PE = 12 × 90 min IRT = 5 × 60 min CBT-I = 7 × 60 min SCT = 12 × 60 min |  | CAPS: NN, NNN |  | Relative to the end of PE (week 6), IRT increased diary-derived with non-sig but medium-large effect size (NM frequency decreased with a large effect size but also did not meet statistical sig) |
Woodward et al [67] | UK | 121 (71 F) | 39 | Civ PTSD | CT-PTSD (weekly or daily) Intensive CT-PSTD | Active (Emotional Supp Therapy—EST) +  Passive | 12weekly over 3 m (standard CT) or daily over 5–7 days (intensive CT) | Ind | NN, NNN |  | Reductions in NN, NNN greater than supportive therapy & the waitlist, including 40w F/U |