An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults

Objectives: Research supports cognitive behavioral therapies for nightmares (CBT-N) in adults. However, nuances of implementation and unstandardized nomenclature for treatment components have created confusion. An expert consensus panel convened to review treatment manual components and develop guidelines for standardized implementation and terminology of CBT-N. The aims are to report the expert panel recommendations. Methods: A literature review identified nightmare treatment manuals tested in randomized clinical trials with adults. The expert panel evaluated content and controversies regarding treatment components and established recommended treatment guidelines based on the literature and clinical experience. Results: Recommendations address appropriate patient presentations for CBT-N and implementation considerations for components including session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The panel evaluated components to inform a consensus CBT-N manual. Conclusions: A comprehensive treatment manual based on expert recommendations will aid dissemination and advance the field by providing clarity. Recommendations reflect the current status of evidence and will need revision as research evolves.