Treating Nightmares Early May Lead More Trauma Survivors to Access Mental Health Care

DETROIT - Nightmares are common in the wake of a traumatic event, and emerging research suggests that offering sleep-focused telehealth therapy early in recovery could help more patients engage in continued mental health care during a critical period.

Initial findings from Henry Ford Health's ongoing RESTED clinical trial show strong engagement in care among trauma patients offered video-based therapy soon after a traumatic event, with more than 76% of those enrolled in the trial going on to begin treatment. By comparison, previous studies have found roughly half of patients discharged from an emergency department go on to attend an outpatient mental health visit.

The preliminary findings could have important implications as research increasingly links nightmares after trauma with a greater risk of serious mental health challenges, including post-traumatic stress disorder and suicidal thoughts, according to Dr. David Moore, PsyD, director of Trauma and Acute Care Surgical Psychology Services at Henry Ford Health and an investigator on the RESTED trial.

"What we're learning is deeply encouraging because it shows there is real interest in treatment for nightmares and that patients are willing to engage in care, especially when we remove some of the traditional barriers," said Moore, author of "The Psychology of Acute Trauma: A Clinician's Guide to Healing and Recovery." "Reaching patients in the days after a traumatic event also gives us an opportunity to address symptoms early and connect survivors with the support they need before more serious mental health challenges potentially emerge."

The RESTED trial enrolls patients within 72 hours of a traumatic event after they have been treated and discharged from one of Henry Ford Health's emergency departments, according to a recent commentary article that researchers published in the Journal of Clinical Sleep Medicine.

Based on their symptoms, patients receive one of four interventions: cognitive behavioral therapy for nightmares, cognitive behavioral therapy for insomnia, sleep education with nightmare education or sleep education without nightmare education. All four are delivered through telehealth video visits, an approach that 100% of patients surveyed have said made the sessions "very easy" to attend. More than 71% said it would have been difficult to attend sessions in person, and nearly 86% said they would prefer video visits for future care.

"We have to think beyond traditional approaches to mental health care to reach more people who may need support after trauma," said Dr. Anthony Reffi, PhD, the study's principal investigator and a psychologist, assistant scientist and co-director of the Sleep and Traumatic Stress Institute at Henry Ford Health. "When we meet patients where they are and make it easier for them to access care, we create more avenues for them to receive the support they need. Our next step is understanding what early interventions for sleep could mean for PTSD risk and long-term recovery."

Understanding whether nightmares can serve as an early entry point to mental health care could have broader implications for people frequently exposed to traumatic events, including military veterans and first responders. Nightmares affect an estimated one in six U.S. veterans and are associated with an increased risk of PTSD and suicidal thoughts and behaviors.

This pilot trial is supported by the American Academy of Sleep Medicine Foundation Strategic Research Grant. Researchers are seeking additional grant funding to build on RESTED and examine whether addressing sleep problems soon after trauma could reduce the risk of PTSD.

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