Table 3 Summary of Non-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 or Age Range | Population | Study Design | Intervention | Sessions | Mode | Outcome measures | % Attrition | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|
Balliett et al [69] | USA | 18 (5 F) | 56.6 | Mil Vet (no PTSD Dx req) | Uncontrolled Before and After | Modified ERRT | 4 × 90–120 min weekly | Ind/Pairs/Both | TRNS: NN, NNN, DI | 0 | Sig reductions in NN, NNN, & DI from pre to 1w F/U with gains maintained at 2 m F/U. 50% of pts reported cessation of NMs |
Berlin et al [70] | USA | 1 (0 F) | 69 | Mil PTSD | Case Study | CBT-I + IRT | 60 min monthly 1 × CBT-I 4 × IRT | Ind | NN | Reduction in NN overall. No analyses. No F/U | |
Bishop et al [71] | USA | 14 (1 + F) | 49.1 | Mil PTSD | Case series | CBT-I + IRT | 8 × weekly Tx sessions | Ind | NFQ: NN | 21.4 | Sig reductions in NN from pre to post and pre to 1 m F/U with large effect sizes |
Cavera et al [72] | USA | 1 (0 F) | 39 | Civ PTSD | Case Study | PE | 20 × 60 min Weekly | Ind | NN, IN | 0 | Extinction of NN pre to halfway through Tx & maintained at post, 1 m & 3 m F/U. No analyses |
Criswell et al [73] | USA | 30 (22 F) | 44 | Civ PTSD | Uncontrolled Before and After | CBT + IRT for those with NMs | 6– 4 sessions weekly (IRT was 1–3 sessions) | Ind | Presence of “distressing dreams” | 20 | Reduction in percentage of pts experiencing “distressing dreams” from (15/30) 50% pre to (1/26) 4% post and 3/24 (13%) at 3 m F/U. Does not separate pts who received IRT. No analyses of sig |
Davis & Wright [74] | USA | 4 (3 F) | 38.5 | Civ PTSD | Case series | Modified IRT + and ERRT | 3 × 120 min weekly + 2 × F/U sessions (3 m/6 m) | Ind | TRNS: NN, IN, SE | 25 | Pre to Post NN extinct for 3 pts & unchanged for the other however reduction in SE (extremely to mildly). At 3 m F/U NN extinct for 2 pts, and unchanged from pre Tx for 2 pts however both with decreases in SE (extremely to mildly). At 6 m F/U, NN extinct for the 3 pts able to be contacted |
Davis et al [75] | USA | 1 (1 F) | 16 | Civ PTSD | Case Study | IRT | 5 sessions (3 Tx + 2 booster at 1 m/3 m) | Ind | DSAL: NN, IN | 0 | No changes from pre to post in NN & IN however discovered pt rescripting incorrectly. This was addressed and NN were extinct at 1 m and 3 m F/Us. No analyses |
Eakman et al [76] | USA | 8 (0 F) | 35.6 | Mil (75% Posttraumatic stress) | Uncontrolled Before and After | CBT-I + brief IRT | 15 × 60 min over 8 weeks | Group/Ind | PSQI-A (does not separate out NM) | 14.3 | Reportedly sig reduction in “sleep disturbances and nightmares” from pre to post. However, does not measure NM alone. No F/U |
Ellis et al [77] | USA | 20 (9 F) | 43.4 | Civ Psychiatric | Case series | Modified IRT at inpatient with pharma/psych support | 4 × 60 min over 3 weeks | Group | DDNSI: total, SE, IN | 0 | NN not stated however sig diff with large effect sizes pre to post for SE, IN, and total scores on DDNSI. No F/U |
Fernandez et al [78] | USA | 2 (2 F) | 8 & 11 | Civ PTSD | Case series | ERRT modified for children | 4 × Tx sessions | Parent/Child | NDQ/TRNS-C: NN, IN, DI | 0 | Overall reduction in NN for both pts, one sig Non-sig pt experienced increase in NN throughout Tx until dramatic decrease after re-writing script & psychoed. Non-sig decrease in IN and DI for one pt and unchanged for the other. No F/U |
Gellis & Gehrman [79] | USA | 11 (0 F) | 58.6 | Mil PTSD | Uncontrolled Before and After | CBT–I | 5 weeks | Ind | NES + NFQ: NNN | 27 | Non-sig slight reduction in NNN & no change in Nightmare Effects. No F/U |
Germain & Nielsen [80] | Canada | 12 (5 F) | 19 to 58 | Civ Mixed (PTSD- NM + idiopath- NM) | Uncontrolled Before and After | IRT | 1 × 180 min | Group | NDQ: NN, DI | 8.3 | At 8.5 weeks post, reductions in retrospective NN for all groups (total, P-NM, I-NM) with medium to large effect sizes but only sig for total. Non-sig increases in prospective NN for all groups (total, P-NM and I-NM) with small to medium effect sizes. Non-sig decreases DI for all groups (total, P-NM and I-NM) with medium to large effect sizes. No F/U |
Germain et al [81] | USA | 10 (7 F) | 33.9 | Civ PTSD | Uncontrolled Before and after | IRT + | 1 × 90-min | Ind | PSQI-A + PSD | 30 | Measured number of dreams in general (not NM specifically), their pleasantness and intensity. At 6w post, all 3 categories showed non sig improvements. Non-sig reduction in “night-time PTSD symptoms”. No F/U |
Grandi et al [82] | Italy | 10 (0 F) | 29 | NM Dx w/o PTSD | Before and after | Exposure | Self-directed 30-60 min daily for 4w via manual | Ind Self-help | NN, IN | 0 | Sig reductions in NN & IN compared to being on waitlist, sustained at 4y F/U |
Harb et al [83] | USA | 11 (0 F) | 37.3 | Mil PTSD | Uncontrolled Before and After | CBT-I + IRT | T = 7/8 (3 × CBT-I + 4/5 IRT) | Ind | NFQ + sleep diaries: NN, IN | 36 | At 1 m post, per NFQ (unknown if NN or NNN) slight mean reduction with small effect size. Per sleep diaries, nil changes in NN however decrease in IN and NN of target NM with small effect sizes. No F/U. No analyses of sig |
Harb et al [84] | USA | 48 (0 F) | 59 | Mil PTSD | Uncontrolled Before and After | IRT | 6 sessions | Group | CAPS: NN, NNN | 21 | Most effective when the rescripted dream incorporates a resolution of the NM theme and excludes violent details |
Hauri et al [85] | USA | 36 (17 F) | 32.71 (6 – 71) 4 children | DNI Civ/Mil Parasomnias (10 NMs) | Uncontrolled Before and after | Hypnotherapy | 1 – 2 × 50 min | Ind | S-Rep on presence or improvement | 40 of NM pts | NM pts not commented on alone for 1 m F/U however for all pts able to be hypnotized, 55.5% reported improvement. At 18 m F/U, of the NM pts 5/7 Indicated “Spell Free or Much Improved”. At 5y F/U 4/6 indicated “Spell Free or Much Improved”. No analyses for sig. High attrition |
Kovacevic & Davis [86] | USA | 1 Trans male | 19 | Civ PTSD | Case Study | ERRT + CPT w/o PE | 5 × ERRT + 12 × CPT | Ind | TRNS/NDQ/NES: NN, SE | 0 | Reduction in NN & SE from pre to post ERRT with NM extinct by session 7 of CPT. Post CPT weekly non trauma related NM were reported at 3 m & 6 m F/U however SE remained lower than pre. No analyses |
Krakow et al [87] | USA | 62 (52 F) | 40 | Civ PTSD NM mixed | Uncontrolled Before and After | IRT + | 3 × weekly Tx sessions + 1 F/U (10 h) | Group | NFQ: NN, NNN | Sig reduction in NN & NNN at 3 m F/U | |
Linden et al [88] | USA | 11 (4 F) | 12.3 | Civ Idiopath(pulmonary patients) | Case series | Self-hypnosis | Unclear | Ind | S-Rep non-directed descriptions of NM/IN | Recurrent NM decreased in frequency or resolved. No statistics. No analyses. No F/U | |
Long et al [89] | USA | 37 (0 F) | 62 | Mil PTSD | No control | IRET | 6 × 90 min | Group | NNN | Large effects for IRET on NNN, & better than control. No F/U | |
Lu et al [90] | USA | 15(0 F) | 55 | Mil PTSD | No control | IRT | 6 × 90 min | Group | NNN, NN, IN | 40 | No immediate post-treatment effects, sig reduced NNN at 3 & 6 m F/U. High attrition |
McNamara et al [91] | USA | 19 (10 F) | 49.9 | Civ (DNS trauma/idiopath) | Uncontrolled Before and After | Virtual reality IRT (ReScript) | 2 × weekly for 4 weeks (8 sessions) | Ind | NFQ/NDQ/NES: NNN, DI | Sig reduction in NNN from pre to post (4 weeks) with small effect size. Sig decrease in DI from pre to post with medium – large effect size. No F/U | |
Miller et al [92] | USA | 8 (4 + F, 2 Trans) | 36.9 | Civ Bipolar Dx with trauma | Uncontrolled Before and After | ERRT-B (addition of bipolar psychoeducation/symptom planning) | 5 × 90 min | Ind | TRNS: NN, NNN, SE | 14.3 | Reductions in mean NN, NNN & SE from pre to post to 3 m F/U with large effect sizes, no comment on significance. NM extinct for 6 of 7 pts at 3 m F/U. SE decreased for all but 1 pt who still reported decrease in NN/NNN |
Moore & Krakow [93] | USA | 11 | - | Mil PTSD | Case series | IRT | 4 × 60 min | Ind | NN | 0 | NN decreased by 44% at 1 m F/U & sig better than control. 4pts showed no improvement. F/U outperformed post-treatment |
Nappi et al [94] | USA | 58 (9 F) | 50 | Mil PTSD | Passive | IRT | 5 × 60–120 min | Ind/Group | NN, NNN, IN | 30 | Sig reductions in NN, NNN and IN. 23% complete remission. No F/U |
Peirce [95] | USA | 1 (0 F) | 10 | Civ psychotic dx, ASD, ID, trauma but no PTSD Dx | Case study | IRT | 5 × IRT sessions over 4 weeks + additional unspecified weekly therapy | Ind | NN via volunteered S-Rep to therapist/teacher | Reduction in NNN from daily to every second day to once a fortnight. No formal stats. No analyses. No F/U | |
Sheaves et al [96] | UK | 7 (4 F) | 39.7 | Civ idiopath dreams, 3/6 PTSD, all with psychotic symptoms | Case series | IRT w/o exposure | × 4–6 | Ind | NN, DI, IN | 16.7 | Overall slight increase in mean NN and overall reductions in mean DI, IN & vividness. No analyses for sig (lack of power). No F/U |
Simbard & Nielsen [68] | Canada | 17 (6 + F) | 6 to 11 | Civ Idiopath | Before & After with partial control. Tx group IRT session 2. Control group received IRT session 3 | IRT with drawing | 3 × 60–90 min over 8 weeks | Mother–Child/Child | DDLI/NDI/NDQ: NN, IN, DI | 35.3 | Sig reductions in DI following psycho-ed only (session 1). After session 2, DI decreased further for 4/6 in IRT group & no further for ¾ in control. Following session 2, decreases in NN for 7 pts, stable for 4 pts, and increased for 2pts (groups unknown). Overall, NMs ceased at 3 m F/U for 5/7 pts. NM ceased at 6 m F/U for 3/6 pts |
Spoormaker et al [97] | The Netherlands | 8 (6 F) | 27.8 | Civ (DNS trauma/idiopath) | Case series | LTD | 1 × 60 min | Ind | NN | 0 | Reduction in mean NN from pre to 2 m F/U. Only 4 pts were able to become lucid, with 3 able to alter the NM lucidly. NM of 3 other pts changed by itself, i.e. without lucidity”. No analyses for significance |
Tufnell [98] | UK | 4 (2 F) | 4 to 11 | Civ PTSD | Case series | EMDR (within multimodal package) | 3 -4 EMDR within 5–7 sessions over 2–6 months | Ind/Parent/Both | Presence of NMs | 25 | NM outcomes only stated for 1 pt (6-year-old male) with no pre NN & DI stated. Per mother – NM extinct at 1 m F/U and maintained at 6 m F/U. No statistics or analyses |
Wanner et al [99] | USA | 2 (0 F) | 58 & 59 | Mil PTSD | Case series | ERRT | 4 × 60 min weekly | Ind | DSAL: NNN | Reduction in NNN from pre to post for 1 pt with further decline at 3 m F/U. Reduction from pre to 3 m F/U for the other pt but increase from pre to post. Significance not commented on | |
White [100] | USA | 1 (0 F) | 20’s | Mil PTSD | Case Study | Embodied Imagination | “several month(s)” | Ind | S-Rep presence of NMs | 0 | NM reported to become extinct at conclusion. No statistics. No analyses. No F/U |
Woo [101] | Singapore | 1 (1 F) | 36 | Civ Idiopath | Case Study | EMDR | 4 × 60 min | Ind | NN, DI | 0 | IN & NN reported to reduce following 1st session. At conclusion dreams still present however without “disturbances”. Doctor report of nil sleep “further” disturbances at 1 m, 3 m, & 5 m F/U |