{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:05:17Z","timestamp":1792523117656,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008569","name":"Oklahoma Center for the Advancement of Science and Technology","doi-asserted-by":"publisher","award":["HR23-158"],"award-info":[{"award-number":["HR23-158"]}],"id":[{"id":"10.13039\/100008569","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study examined the efficacy of a five-module cognitive behavioral therapy for nightmares in children (CBT-NC) and improving sleep.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Forty-six youth aged 6\u201317 years with sleep problems and at least weekly chronic and distressing nightmares were randomized to treatment (<jats:italic>n<\/jats:italic> = 23) or waiting list (<jats:italic>n<\/jats:italic> = 23) using a block four randomized design. Among participants, 65% (<jats:italic>n<\/jats:italic> = 30) were White, 4% (<jats:italic>n<\/jats:italic> = 2) were Black\/African American, 2% (<jats:italic>n<\/jats:italic> = 1) were Asian American, 13% (<jats:italic>n<\/jats:italic> = 6) were Native American or Pacific Islander, and 15% (<jats:italic>n<\/jats:italic> = 7) were multiracial. Fifty percent of participants (<jats:italic>n<\/jats:italic> = 23) were cisgender girls, 35% were cisgender boys (<jats:italic>n<\/jats:italic> = 16), 7% were transgender boys (<jats:italic>n<\/jats:italic> = 3), and 9% were gender non-binary (<jats:italic>n<\/jats: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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a statistically significant improvement in the number of nights with awakening (Cohen's <jats:italic>d<\/jats:italic> = 1.08), the number of weekly nightmares (Cohen's <jats:italic>d<\/jats:italic> = 0.82), and nightmare distress (Cohen's <jats:italic>d<\/jats: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 (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) but did not reach statistical significance for between-subjects analyses of the treatment group compared to the wait-list group (<jats:italic>p<\/jats: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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats: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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>https:\/\/clinicaltrials.gov\/study\/NCT05588739<\/jats:ext-link>, identifier: NCT05588739.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frsle.2024.1401023","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T04:51:24Z","timestamp":1720673484000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy of a telehealth cognitive behavioral therapy for improving sleep and nightmares in children aged 6\u201317"],"prefix":"10.3389","volume":"3","author":[{"given":"Lisa DeMarni","family":"Cromer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Beth","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Prince","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hollman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissar","family":"El Sabbagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara R.","family":"Buck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"B1","volume-title":"Manual for the ASEBA School-Age Forms and Profiles","author":"Achenbach","year":"2001"},{"key":"B2","doi-asserted-by":"publisher","first-page":"179","DOI":"10.4324\/9781410610621-7","article-title":"\u201cThe Achenbach System of Empirically Based Assessment (ASEBA) for ages 1.5 to 18 years\u201d","author":"Achenbach","year":"2004","journal-title":"The Use of Psychological Testing for Treatment Planning and Outcomes Assessment: Instruments for Children and Adolescents"},{"key":"B3","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s10567-017-0234-5","article-title":"Systematic review and meta-analysis of adolescent cognitive\u2013behavioral sleep interventions","volume":"20","author":"Blake","year":"2017","journal-title":"Clin. 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