Examining changes in nightmare distress and frequency across treatment in a child sample: Which improves first?

Abstract

Theories of nightmare chronicity suggest that the distress experienced as a result from the nightmare creates and sustains the coercive nightmare cycle. However, changes in nightmare severity throughout treatment has not been studied. We sought to understand how characteristics of nightmares may relate to breaking a cycle of nightmares in order to disrupt nightmare persistence. We examined changes in nightmare distress and nightmare frequency in a cognitive-behavioral treatment for nightmares for children, specifically testing the prediction that nightmare distress would improve before nightmare frequency. Seventeen children experiencing post-traumatic nightmares between the ages of 5 to 17 participated in a brief, five-session cognitive behavioral therapy to address their trauma-related nightmares. Data from pre-treatment, five therapy sessions, and post-treatment were used in the analyses. Helmert contrasts were used to examine improvement over time by comparing the mean of each variable at each progressive time point to the mean of the subsequent time points. While treatment was significantly related to reduced nightmare distress and frequency from pre-treatment to post-treatment, our findings did not support our hypothesis that nightmare distress would improve before nightmare frequency. Nightmare frequency saw a decline sooner than did nightmare distress. Nevertheless, these findings demonstrate that, as treatment progresses, significant reductions in nightmare distress occur, which may further disrupt the nightmare cycle. Implications for treatment are discussed.