{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:00:01Z","timestamp":1782990001904,"version":"3.54.5"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Recurrent nightmares often severely impair the quality of life, school functioning, and daily functioning of trauma-exposed children and adolescents. However, research to date is limited for treatments focused on reducing the impact of posttraumatic nightmares among youth in conflict zones. This study aimed to investigate the outcome of the Better Learning Program 3 (BLP) as it was implemented in over 100 schools in Gaza (2012\u20132017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Treatment outcome was investigated in an open trial among war- and conflict-exposed students (6\u201317 years of age) in Gaza (\n                      <jats:italic>N<\/jats:italic>\n                      = 1093). All participants sought help with nightmares and sleep disturbance and reported recurrent traumatic nightmares on average 4.86 nights per week. The intervention was inspired by imagery rehearsal therapy and trauma-focused cognitive behavioral therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Students experienced significant week-to-week reductions in reported nightmares throughout the 8-week intervention. Approximately half of the participants reported no nightmares post-treatment, and a further 47% reported a reduction in nightmare frequency. In a 10-month follow-up, 42% of a smaller sample (\n                      <jats:italic>n<\/jats:italic>\n                      = 215) maintained treatment gains and remained free of nightmares, whereas 42% maintained a reduction of nightmares to one or two per week. Students with relapse responded effectively to booster sessions offered after follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The current study demonstrates the apparent success of this school-based treatment, showing that it is both feasible to intervene directly with students' nightmare disturbance and to significantly reduce their nightmare frequency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frsle.2025.1658555","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:11:50Z","timestamp":1767849110000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Treating war- and conflict-related nightmares in children and youth: outcomes of a school-based intervention"],"prefix":"10.3389","volume":"4","author":[{"given":"Jon H\u00e5kon","family":"Schultz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"June","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Alisic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safwat","family":"Diab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerlinde","family":"Harb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/S0140-6736(19)30590-2","article-title":"Determinants of food insecurity in occupied Palestinian territory: a cross-sectional survey","volume":"393","author":"Ahmadi","year":"2019","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.smrv.2012.06.001","article-title":"Randomized controlled trials of psychological and pharmacological treatments for nightmares: a meta-analysis","volume":"17","author":"Augedal","year":"2013","journal-title":"Sleep Med. Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1093\/sleep\/28.9.1135","article-title":"Suicidality and sleep disturbances","volume":"28","author":"Bernert","year":"2005","journal-title":"Sleep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1080\/09638237.2019.1608936","article-title":"Assessment of mental health and psycho-social support pilot program's effect on intended stigmatizing behavior at the Saftawi Health Center, Gaza: a cross-sectional study","volume":"28","author":"Bruno","year":"2019","journal-title":"J. Ment. Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.chc.2023.08.001","article-title":"Trauma exposure in migrant children: impact on sleep and acute treatment interventions","volume":"33","author":"Bryant","year":"2024","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"B6","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.cpr.2012.06.002","article-title":"A meta-analysis of imagery rehearsal for post-trauma nightmares: effects on nightmare frequency, sleep quality, and posttraumatic stress","volume":"32","author":"Casement","year":"2012","journal-title":"Clin. Psychol. Rev."},{"key":"B7","volume-title":"Trauma-focused CBT for Children and Adolescents: Treatment Applications","author":"Cohen","year":"2012"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1401023","DOI":"10.3389\/frsle.2024.1401023","article-title":"Efficacy of a telehealth cognitive behavioral therapy for improving sleep and nightmares in children aged 6\u201317. Front","volume":"3","author":"Cromer","year":"2024","journal-title":"Sleep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1177\/15346501221081122","article-title":"Case study of cognitive behavioral therapy for nightmares in children with and without trauma history","volume":"21","author":"DeMarni Cromer","year":"2022","journal-title":"Clin. Case Stud."},{"key":"B10","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/j.1365-2214.2011.01246.x","article-title":"A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East","volume":"38","author":"Dimitry","year":"2011","journal-title":"Child Care Health Dev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.smrv.2023.101834","article-title":"A systematic review of nightmare prevalence in children","volume":"71","author":"El Sabbagh","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2019.01031","article-title":"Effectiveness of a school-based intervention on the students' mental health after exposure to war-related trauma","volume":"1031","author":"El-Khodary","year":"2020","journal-title":"Front. Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","first-page":"409","DOI":"10.2147\/NSS.S166089","volume":"10","author":"El-Solh","year":"2018","journal-title":"Nat. Sci. Sleep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/1534650112462623","article-title":"A case series: cognitive-behavioral treatment (exposure, relaxation, and rescripting therapy) of trauma-related nightmares experienced by children","volume":"12","author":"Fernandez","year":"2013","journal-title":"Clin. Case Stud."},{"key":"B15","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1186\/s12888-023-04703-1","article-title":"Psychosocial treatments for nightmares in adults and children: a systematic review","volume":"23","author":"Gill","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1080\/10926770903035150","article-title":"PTSD nightmares and sleep disturbance in Iraq war veterans: a feasible and promising treatment combination","volume":"18","author":"Harb","year":"2009","journal-title":"J. Aggress. Maltreat. Trauma"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0242414","DOI":"10.1371\/journal.pone.0242414","article-title":"Posttraumatic nightmares and school functioning in war-affected youth","volume":"15","author":"Harb","year":"2020","journal-title":"PLoS ONE"},{"key":"B18","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1521\/psyc.2007.70.4.283","article-title":"Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence","volume":"70","author":"Hobfoll","year":"2007","journal-title":"Psychiatry"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e0210071","DOI":"10.1371\/journal.pone.0210071","article-title":"Effects of armed conflict on child health and development: a systematic review","volume":"14","author":"Kadir","year":"2019","journal-title":"PLoS ONE"},{"key":"B20","doi-asserted-by":"publisher","first-page":"501","DOI":"10.5664\/jcsm.2678","article-title":"Sleep disturbance in pediatric PTSD: current findings and future directions","volume":"9","author":"Kovachy","year":"2013","journal-title":"J. Clin. Sleep Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/S1054-139X(00)00195-6","article-title":"Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility","volume":"29","author":"Krakow","year":"2001","journal-title":"J. Adolesc. Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1037\/0033-2909.133.3.482","article-title":"Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model","volume":"133","author":"Levin","year":"2007","journal-title":"Psychol. Bull."},{"key":"B23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4159\/9780674270534-003","article-title":"\u201cChildren's traumatic dreams,\u201d","author":"Nader","year":"1996","journal-title":"Trauma and Dreams"},{"key":"B24","year":"2011","journal-title":"Better Learning Programme 3: Better Sleep by Facing Your Nightmares\u2014Group and Individual Sessions"},{"key":"B25","year":"2022","journal-title":"Better Learning Program 2: Group Sessions. Improving Study Skills, Education in Emergencies"},{"key":"B26","year":"2025","journal-title":"Better Learning Programme 1: Supporting Students' Recovery in Emergencies, Classroom Sessions"},{"key":"B27","year":"2025","journal-title":"Better Learning Programme 3: Better Sleep by Facing Your Nightmares\u2014Group and individual Sessions"},{"key":"B28","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1024\/1422-4917\/a000246","article-title":"Prevalence and intensity of nightmares in traumatized and nontraumatized children and adolescents","volume":"41","author":"Ossa","year":"2013","journal-title":"Z. Kinder Jugendpsychiatr. Psychother."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/15402002.2024.2437634","article-title":"An expert consensus statement for implementing cognitive behavioral therapy for nightmares in adults","volume":"23","author":"Pruiksma","year":"2025","journal-title":"Behav. Sleep Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1176\/ajp.146.6.697","article-title":"Sleep disturbance as the hallmark of posttraumatic stress disorder","volume":"146","author":"Ross","year":"1989","journal-title":"Am. J. Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.smrv.2017.08.004","article-title":"The mechanisms of action underlying the efficacy of psychological nightmare treatments: a systematic review and thematic analysis of discussed hypotheses","volume":"39","author":"Rousseau","year":"2018","journal-title":"Sleep Med. Rev"},{"key":"B32","volume-title":"Narrative Exposure Therapy: A Short-Term Intervention for Traumatic Stress Disorders after War, Terror, or Torture","author":"Schauer","year":"2005"},{"key":"B33","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.smrv.2010.06.002","article-title":"Gender differences in nightmare frequency: a meta-analysis","volume":"15","author":"Schredl","year":"2011","journal-title":"Sleep Med. Rev."},{"key":"B34","doi-asserted-by":"publisher","first-page":"423","DOI":"10.2147\/NSS.S282967","article-title":"Prevalence and characteristics of post-traumatic nightmares in war- and conflict-affected students","volume":"13","author":"Schultz","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"B35","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/s40653-019-00268-y","article-title":"Nightmares in treatment-seeking youth: the role of cumulative trauma exposure","volume":"13","author":"Secrist","year":"2019","journal-title":"J. Child Adolesc. Trauma"},{"key":"B36","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1037\/a0017945","article-title":"Adaptation of imagery rehearsal therapy for nightmares in children: a brief report","volume":"46","author":"Simard","year":"2009","journal-title":"Psychotherapy"},{"key":"B37","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1080\/15402000902762360","article-title":"Imagery rehearsal therapy for frequent nightmares in children","volume":"7","author":"St-Onge","year":"2009","journal-title":"Behav. Sleep Med."},{"key":"B38","unstructured":"Report of the Independent Commission of Inquiry on the 2014 Gaza Conflict. A\/HRC\/29\/52\n          \n          2015"},{"key":"B39","volume-title":"United Nations Human Rights Report 2022","year":"2022"},{"key":"B40","unstructured":"Jerusalem, Israel\n          UNOCHA\n          Fragmented Lives: Humanitarian Overview\n          \n          2013"},{"key":"B41","volume-title":"Humanitarian Needs Overview","year":"2018"},{"key":"B42","unstructured":"Jerusalem, Israel\n          UNOCHA\n          Overview: 2010\u20132019: A Decade in Numbers\n          \n          2020"},{"key":"B43","volume-title":"Better Sleep\u2014Solving Sleeping Problems for Pupils Living in Ongoing Conflict","year":"2017"},{"key":"B44","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.chiabu.2017.11.020","article-title":"Trauma characteristics and sleep impairment among trauma-exposed children","volume":"76","author":"Wamser-Nanney","year":"2017","journal-title":"Child Abuse Negl."}],"container-title":["Frontiers in Sleep"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2025.1658555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:11:53Z","timestamp":1767849113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2025.1658555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":44,"alternative-id":["10.3389\/frsle.2025.1658555"],"URL":"https:\/\/doi.org\/10.3389\/frsle.2025.1658555","relation":{},"ISSN":["2813-2890"],"issn-type":[{"value":"2813-2890","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,8]]},"article-number":"1658555"}}