AUTHOR=Cromer Lisa DeMarni , Bell Sarah Beth , Prince Lauren E. , Hollman Nicholas , El Sabbagh Elissar , Buck Tara R. 

TITLE=Efficacy of a telehealth cognitive behavioral therapy for improving sleep and nightmares in children aged 6–17

JOURNAL=Frontiers in Sleep

VOLUME=3

YEAR=2024

URL=https://www.frontiersin.org/journals/sleep/articles/10.3389/frsle.2024.1401023

DOI=10.3389/frsle.2024.1401023

ISSN=2813-2890

ABSTRACT=<sec><title>Introduction</title><p>This study examined the efficacy of a five-module cognitive behavioral therapy for nightmares in children (CBT-NC) and improving sleep.</p></sec><sec><title>Materials and methods</title><p>Forty-six youth aged 6–17 years with sleep problems and at least weekly chronic and distressing nightmares were randomized to treatment (<italic>n</italic> = 23) or waiting list (<italic>n</italic> = 23) using a block four randomized design. Among participants, 65% (<italic>n</italic> = 30) were White, 4% (<italic>n</italic> = 2) were Black/African American, 2% (<italic>n</italic> = 1) were Asian American, 13% (<italic>n</italic> = 6) were Native American or Pacific Islander, and 15% (<italic>n</italic> = 7) were multiracial. Fifty percent of participants (<italic>n</italic> = 23) were cisgender girls, 35% were cisgender boys (<italic>n</italic> = 16), 7% were transgender boys (<italic>n</italic> = 3), and 9% were gender non-binary (<italic>n</italic> = 4). The baseline nightmare persistence ranged from 6 months to 13.5 years. The treatment adapted exposure, relaxation, and rescription therapy for trauma-related nightmares in adults and added elements of cognitive behavioral therapy for insomnia in children. Psychoeducation included topics of sleep and nightmares, relaxation, anxiety management, and sleep hygiene; the youth were guided through nightmare exposure and rescription.</p></sec><sec><title>Results</title><p>There was a statistically significant improvement in the number of nights with awakening (Cohen's <italic>d</italic> = 1.08), the number of weekly nightmares (Cohen's <italic>d</italic> = 0.82), and nightmare distress (Cohen's <italic>d</italic> = 1.05) for the treatment group compared to the wait-list group. Parent-reported youth sleep improved for the entire group from pretreatment to posttreatment (<italic>p</italic> &lt; 0.001) but did not reach statistical significance for between-subjects analyses of the treatment group compared to the wait-list group (<italic>p</italic> = 0.05). Between-subjects analyses saw improvement for the treatment group compared to the wait-list group on internalizing and externalizing problems and suicidal thoughts and behaviors.</p></sec><sec><title>Discussion</title><p>This study supports the efficacy of CBT-NC for improving sleep maintenance, nightmare frequency and distress, and other mental health difficulties in youth. Preliminary evidence of possibly improving suicidal thinking and behavior is also presented.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/study/NCT05588739" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/study/NCT05588739</ext-link>, identifier: NCT05588739.</p></sec>