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Pilot Results of a Novel Treatment for Posttraumatic Nightmares in a Military and Veteran Sample Nightmares are prevalent in service members and veterans.1,2 They impact mental health and daytime function3 and are often resistant to evidence-based treatments.4 Trauma activation is a mechanism of change in PTSD exposure treatments.5 Thus, a treatment that uses exposure to nightmare content to activate trauma memories could facilitate recovery. Cardiovascular activity (CVA) and electrodermal activity (EDA) can be monitored in session as objective evidence of trauma activation,6 and actigraphy can be used to classify sleep-wake cycles and identify nightmare events. This single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for trauma-related nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection. Service members and veterans (N=11) with post-trauma nightmares and insomnia were recruited at Walter Reed National Military Medical Center. They received 8 sessions of NDR over 8 weeks. Potential efficacy was determined by change from baseline to 1-month follow up in self-reported nightmares and insomnia. Objective measures of change included CVA, EDA, and actigraphy data collected with the Empatica E4 wristband. Wristband data was also used to calculate operational stress index (OSI) to detect evidence of nightmares events during sleep. With a large effect for decrease in nightmares and a small effect for insomnia, our results provide a signal of NDR’s potential efficacy for treating trauma-related nightmares. CVA and EDA results indicate that data collected from the Empatica wristband data are feasible markers of in-session stress related to nightmare exposure. Further, wristband data can be used to calculate nighttime OSI as a marker of nightmare events. These results provide a rationale for conducting the next phase of investigation, which is comparing process and outcome for NDR (exposure) and, RITM0039869, Nightmares are prevalent in service members and veterans.1,2 They impact mental health and daytime function3 and are often resistant to evidence-based treatments.4 Trauma activation is a mechanism of change in PTSD exposure treatments.5 Thus, a treatment that uses exposure to nightmare content to activate trauma memories could facilitate recovery. Cardiovascular activity (CVA) and electrodermal activity (EDA) can be monitored in session as objective evidence of trauma activation,6 and actigraphy can be used to classify sleepwake cycles and identify nightmare events. This single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for trauma-related nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection.

Nightmare Deconstruction and Reprocessing: Final Pilot Results of a Treatment for Trauma-Related Nightmares and Insomnia Nightmares are prevalent in service members and veterans,1,2 they impact mental health and daytime function,3 and they are often resistant to evidence-based treatments.4 Because trauma activation is a mechanism of change in exposure-based PTSD treatments,5 a treatment that uses nightmare content to activate trauma memories could facilitate recovery. Cardiovascular and electrodermal activity can be monitored in session as objective evidence of the stress of trauma activation,6 and actigraphy can be use to classify sleep-wake cycles and identify nightmare events. A single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for trauma-related nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection. Eleven active duty service members and veterans with trauma-related nightmares and insomnia were recruited at Walter Reed National Military Medical Center. Potential efficacy of NDR is determined by pre-to- post-treatment change in nightmares and insomnia, and HRV, EDA, and actigraphy via Empatica E4 wristband. An operational stress index (OSI) was used to examine wristband data for evidence of nightmares during sleep periods. Feasibility of time-sensitive blood draws was also tested; assay analyses are not yet available. With a large treatment effect for nightmares, these results provide a preliminary signal of NDR’s efficacy. Cardiovascular and EDA results indicate the feasibility of wristband data as a marker of in-session stress related to exposure and of the use of nighttime OSI as a marker of nightmare events that can be used to compare pre- and post-treatment nightmare frequency. These provide a rationale for conducting the next phase of investigation of NDR and the use of physiologic data as process and outcome markers of change. 1. Creamer JL et al. Nightmares in U.S. militar, RITM0028601, Nightmares are prevalent in service members and veterans,1,2 they impact mental health and daytime function,3 and they are often resistant to evidencebased treatments.4 Because trauma activation is a mechanism of change in exposure-based PTSD treatments,5 a treatment that uses nightmare content to activate trauma memories could facilitate recovery. Cardiovascular and electrodermal activity can be monitored in session as objective evidence of the stress of trauma activation,6 and actigraphy can be use to classify sleepwake cycles and identify nightmare events. A single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for trauma-related nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection.

Nightmare Deconstruction and Reprocessing: Proof of Concept of a Novel Treatment for PTSD-Related Nightmares and Insomnia Nightmares are prevalent in service members and veterans,1,2 they impact mental health and daytime function,3 and they are often resistant to evidence-based treatments.4 Trauma activation is a mechanism of change in exposure-based PTSD treatments.5 Thus, a treatment that uses nightmare content to activate trauma memories could facilitate recovery. Cardiovascular activity and electrodermal activity (EDA) can be monitored in session as objective evidence of trauma activation,6 and actigraphy can be used to classify sleep-wake cycles and identify nightmare events. This single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for trauma-related nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection. Eleven active duty service members and veterans with trauma-related nightmares and insomnia at Walter Reed National Military Medical Center were given 8 sessions of NDR over 8 weeks. Potential efficacy of NDR was determined by pre-to-post-treatment change in self-reported nightmares and insomnia. Objective measures of change included cardiovascular, EDA, and actigraphy data collected via the Empatica E4 wristband. An operational stress index (OSI) was used to examine wristband data for evidence of nightmares during sleep periods. With a large treatment effect for nightmares, these results provide a preliminary signal of NDR’s efficacy. Cardiovascular and EDA results indicate the feasibility of wristband data as a marker of in-session stress related to exposure and of the use of nighttime OSI as a marker of nightmare events that can be used to compare pre- and post-treatment nightmare frequency. These provide a rationale for conducting the next phase of investigation of NDR and the use of physiologic data as process and outcome markers of change. 1. Creamer JL et al. Nightmares in, RITM0030335, Nightmares are prevalent in service members and veterans,1,2 they impact mental health and daytime function,3 and they are often resistant to evidencebased treatments.4 Trauma activation is a mechanism of change in exposurebased PTSD treatments.5 Thus, a treatment that uses nightmare content to activate trauma memories could facilitate recovery. Cardiovascular activity and electrodermal activity (EDA) can be monitored in session as objective evidence of trauma activation,6 and actigraphy can be used to classify sleep-wake cycles and identify nightmare events. This single-arm pilot trial tested Nightmare Deconstruction and Reprocessing (NDR)7 for traumarelated nightmares. Aims were to test the potential efficacy of NDR and the feasibility of biomarker data collection.