DARC-NESS: a mastery-based cognitive-behavioral model for treating chronic nightmares in youth

TL;DR

This paper introduces DARC-NESS, a new model for understanding and treating chronic nightmares in children using cognitive-behavioral therapy.

Contribution

The paper introduces DARC-NESS, a novel cognitive-behavioral model emphasizing nightmare self-efficacy as a key factor in chronic nightmare maintenance.

Findings

DARC-NESS identifies seven interacting components that perpetuate chronic nightmares in youth.

The model provides a theoretical framework for CBT interventions targeting each component of nightmare maintenance.

A case illustration demonstrates how modular interventions based on DARC-NESS can disrupt chronic nightmare cycles.

Abstract

Theories of chronic nightmare maintenance highlight dysfunctional beliefs about sleep and nightmares, distress and arousal, anticipatory anxiety, maladaptive sleep habits, and sleep deprivation as perpetuating factors that maintain nightmare disorder over time. Theories of nightmare treatment suggest that self-efficacy is a common factor in nightmare mitigation. The current article introduces DARC-NESS, a multi-component theory of nightmare maintenance that emphasizes nightmare self-efficacy as a central mechanism influencing the maintenance cycle at multiple points. DARC-NESS is a mnemonic for the model's components: Dream (nightmare) content, Appraisals, Resources for regulation, Conditioned arousal, Nightmare Efficacy, Sleep hygiene and patterns, and Sleep quality and quantity, that interact to perpetuate nightmares. This model provides the theoretical basis for cognitive behavioral therapy (CBT) for child nightmares. The manuscript proposes treatment counterparts to each model component and presents a case illustration demonstrating how these interventions can disrupt the vicious cycle of chronic nightmares. Finally, flexible clinical applications are offered to guide clinicians in selecting and sequencing modular intervention elements to match individual case presentations.

Figures