Imagery Rescripting for Posttraumatic Nightmares in Rural Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans With Posttraumatic Stress Disorder (PTSD)

Study Overview
=================
Brief Summary
-----------------
Many service members returning from Iraq and Afghanistan have difficulties adjusting back to civilian life. Research shows that symptoms of posttraumatic stress disorder (PTSD) are particularly high in returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans, and that combat-related nightmares and sleep disturbances are common in veterans with PTSD. This is of concern because people with these problems will often use unhealthy ways of coping. Although combat-related nightmares and difficulty sleeping are highly distressing, there are helpful treatments that do not involve taking medication. One of these treatments teaches specific skills to help people improve their sleep habits and to change their nightmares so that they are less upsetting. This treatment can be very helpful and research shows that people experience decreases in the frequency and severity of their nightmares, decreased symptoms of depression and PTSD, and improved sleep quality and quantity after completing treatment. However, because this treatment has only been studied with civilians, it is not clear how well this treatment works for returning veterans. This study tests how well this treatment works in treating combat nightmares in veterans who also have PTSD from experiencing a traumatic event.

Official Title
-----------------
Imagery Rescripting for Posttraumatic Nightmares in Rural Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans With Posttraumatic Stress Disorder (PTSD)

Conditions
-----------------
Sleep Disorders, Stress Disorders, Post-Traumatic

Intervention / Treatment
-----------------
* Behavioral: MEDVAMC Nightmare Treatment
* Behavioral: Telepsychiatry Nightmare Treatment


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients for the open trial will be OEF/OIF veterans (aged 18-64); English-speaking; currently enrolled in the Trauma Recovery Program (TRP) at the Michael E. DeBakey Veteran Affairs Medical Center (MEDVAMC); reporting at least one combat or war zone associated PTNM in the past week; have an existing PTSD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM); and consenting to be in an open trial for treatment of PTNM. In addition, patients must agree to allow their assessment and therapy sessions to be video/audiotaped for the purposes of supervision. Pilot Study: Patients for the pilot study will be OEF/OIF veterans (aged 18-64); English-speaking; currently enrolled in the Conroe CBOC for their primary or mental health care; reporting at least one combat or war zone associated PTNM in the past week; have an existing PTSD ICD-9-CM diagnosis; and consenting to be in the pilot study for treatment of PTNM. In addition, patients must agree to allow their assessment and therapy sessions to be video/audiotaped for the purposes of supervision. Exclusion Criteria: Patients will be excluded for the following reasons: current active suicidal/homicidal ideation and intent; current substance dependence; a diagnosis of bipolar or psychosis; active participation in another psychosocial treatment for PTSD; prescribed the medication Prazosin (a psychotropic medication for the treatment of nightmares). Patients interested in receiving the intervention will not be excluded if they are taking psychotropic medication (except for Prazosin) and may continue to take their medication as prescribed throughout the study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>MEDVAMC Nightmare Treatment | Behavioral: MEDVAMC Nightmare Treatment<br>* Veteran Nightmare Treatment Using Imagery Rescripting<br>|
| Experimental: 2<br>Videoconferencing nightmare Treatment | Behavioral: Telepsychiatry Nightmare Treatment<br>* Veteran Nightmare Treatment Using Imagery Rescripting Through Videoconferencing<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinician Administered PTSD Scale (CAPS), Posttraumatic Stress Symptom Scale-Self-Report (PSS-SR) & Beck Depression Inventory-II (BDI-II) |  | Baseline & post-treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Posttraumatic Cognitions Inventory (PTCI). |  | Baseline & post-treatment | 
| The Pittsburgh Sleep Quality Index-Addendum for PTSD (PSQI) |  | Baseline & post-treatment | 
| Trauma Related Nightmare Survey (TRNS). |  | Baseline & post-treatment | 
| Mini-International Neuropsychiatric Interview (MINI) |  | Baseline | 
| Treatment Evaluation Inventory (TEI) |  | Post-treatment | 
| Client Satisfaction Questionnaire (CSQ) |  | Post-treatment |