Nightmare Deconstruction and Reprocessing vs. NightWare Wristband

The overall goal of this Phase IIa randomized controlled pilot trial is to assess the potential efficacy of two emerging treatments for post-trauma nightmares and to test the feasibility of study design and methods. Symptom change will be assessed in two treatment arms: (1) Nightmare Deconstruction and Reprocessing (NDR), an exposure-based psychotherapy; and (2) NightWare (NW), a non-exposure approach using a wristband device. The investigators will also assess the feasibility of circadian-dependent blood sampling and use of another wristband to collect physiologic data. Specific aims are: (1) Compare evidence of how well participants tolerate and comply with the two treatments and test feasibility of methods and procedures; (2) Collect additional evidence of the potential efficacy of two contrasting non-pharmacologic approaches to treating posttraumatic nightmares; (3) Explore the operational stress index (OSI) as a reliable, objective measure of sleep disturbance and nightmare events.

Inclusion Criteria: * Active duty service members and veterans * Minimum symptom severity: * Has had at least 1 nightmare per week for the past month * Has a minimum ISI score of 8 * If taking medications for PTSD, depression, anxiety, or insomnia, must be on stable dose for 8 weeks. Exclusion Criteria: * Serious risk of suicide * Psychosis, bipolar disorder, or alcohol or substance use disorder * Untreated moderate to severe sleep apnea * Use of synthetic glucocorticoid beta blockers, prazosin, or varenicline * Current evidence-based or experimental psychotherapy directly targeting nightmares, insomnia, or PTSD * Inability to recall nightmare content * Inability to wear wristband or sync wristband data * Inability to comply with blood draws * Refusal to consent to DNA analysis of blood samples * Refusal to consent to audio recording of study visits * REM sleep behavior disorder or narcolepsy as determined by investigator