Providers' use and perceived benefits and barriers of delivering cognitive behavioral therapy for nightmares (CBT-N) to veterans.

Abstract

Training and consultation in cognitive behavioral therapy for nightmares (CBT-N) were introduced for Veterans Health Administration (VHA) providers to reduce the frequency and severity of nightmares and improve functioning of veterans experiencing chronic nightmares. This study aimed to evaluate providers' sustained delivery of CBT-N and their perceptions of benefits and barriers to implementation to improve the successful adoption and long-term use of CBT-N throughout the VHA. VHA providers (N = 100) who completed the CBT-N training program at least 6 months prior to the study were sent an online survey about their continued use, feedback, and perceptions of CBT-N. The survey received a 65% response rate. Overall, perceptions of CBT-N were favorable. Ninety-five percent of providers reported continued delivery of CBT-N since completing the training program, with 100% of responders intending to use CBT-N in the future. Among CBT-N users, treatment was perceived to reduce nightmare frequency and/or severity and improve other domains of functioning (i.e., sleep health, trauma symptoms, quality of life). A third of the CBT-N users denied any barriers to using CBT-N. Primary barriers to use were related to providers' facility inner setting (e.g., unable to accommodate required session length or frequency, veteran population not appropriate for CBT-N) or veteran factors (e.g., schedule constraints, patient decision in shared decision making). Results encourage ongoing CBT-N training initiatives within the VHA. Directly tracking veteran outcomes and identifying necessary modifications to adapt CBT-N within the constraints of the inner setting, while preserving treatment integrity, are warranted to ensure and promote intervention effectiveness. (PsycInfo Database Record (c) 2026 APA, all rights reserved).