PCMHI clinicians perceive greater CBT-N benefits than clinicians in other settings but face significant barriers including scheduling constraints, suggesting that adapting CBT-N for primary care settings could increase uptake and improve access to nightmare treatment within the VHA.
Nightmares are common and often undertreated among veterans and are associated with various biopsychosocial issues.
PCMHI clinicians perceived greater CBT-N benefits compared to clinicians in other settings.
PCMHI clinicians reported significant barriers to delivering CBT-N, particularly scheduling constraints.
In a subanalysis, PCMHI clinicians rated CBT-N as significantly less appropriate and feasible than clinicians in other settings.
Program evaluation data showed overall positive clinician perceptions of CBT-N across settings, while also revealing implementation barriers.
The authors conclude that adapting CBT-N for PCMHI settings is supported as a pathway to increased uptake and improved access to nightmare treatment.
This research examined how clinicians working within the Veterans Health Administration (VHA) perceive a therapy called Cognitive Behavioral Therapy for Nightmares (CBT-N), with a particular focus on those working in primary care mental health settings (called PCMHI). Nightmares are a common but often untreated problem among veterans, and the VHA has been training clinicians to deliver CBT-N to address this gap. Surveys of 77 trained clinicians found that those in primary care settings actually valued the therapy more than clinicians in other settings — but they also faced more barriers to delivering it, especially around scheduling, because primary care mental health care is typically brief and time-limited, which does not fit well with CBT-N's structure. A smaller follow-up analysis comparing just 3 PCMHI clinicians to 12 clinicians in other settings found that the primary care clinicians considered CBT-N significantly less appropriate and feasible for their work environment, even while valuing its benefits. This tension — high perceived benefit but low perceived fit — suggests that the therapy as currently designed does not translate easily into primary care mental health settings without modification. This research suggests that modifying or adapting CBT-N specifically for use in primary care mental health settings could be an important step toward getting more veterans access to nightmare treatment. Because primary care is often where veterans first seek mental health help, making an effective nightmare therapy work in that context could meaningfully expand access. The authors note these are preliminary findings based on small samples, and further research would be needed to confirm and build on them.
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Upload Your LabsBolstad C, Fung C, Davis L, Zubkoff L, Bramoweth A, Austin A, et al.. (2026). 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.. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. https://doi.org/10.1007/s44470-026-00073-z