Delivering Cognitive Behavioral Therapy for Nightmares (CBT-N) in primary care within the Veterans Health Administration: A preliminary report on clinician-perceived barriers and benefits.

Nightmares, which are associated with various biopsychosocial issues, are common and often undertreated among veterans. To address the demand for Cognitive Behavioral Therapy for Nightmares (CBT-N) in the Veterans Health Administration (VHA), experts have trained mental health clinicians in its delivery. Program evaluation data show positive clinician perceptions of CBT-N but reveal implementation barriers, including the incompatibility between CBT-N and certain practice settings. One such setting is Primary Care Mental Health Integration (PCMHI), where brief episodes of care may limit CBT-N feasibility. Survey results suggest PCMHI clinicians (n=13) perceive greater CBT-N benefits than clinicians in other settings (n=64) but face barriers such as scheduling constraints. A subanalysis showed that PCMHI clinicians (n=3) find CBT-N to be significantly less appropriate and feasible than clinicians in other settings (n=12). These preliminary findings support adapting CBT-N for PCMHI as a pathway to increased uptake and improved access to nightmare treatment within the VHA.