Adapting Cognitive Behavioral Therapy for Nightmare Disorder in Children: Lisa Cromer, PhD

WATCH TIME: 5 minutes

"We believe nightmares are learned—and just like panic or OCD, it’s not the experience itself, but the response to it that maintains the disorder."

Nightmares are common in childhood, especially between the ages of 3 and 10 years, when imagination is developing rapidly. Estimates suggest that 20% to 50% of children experience occasional nightmares, with about 1% to 5% experiencing frequent or distressing nightmares that interfere with sleep or daytime functioning. Some of these nightmares may be more prevalent in children with high levels of stress, trauma exposure, or sleep disorders or irregular sleep routines.

In recent years, cognitive behavioral therapy (CBT) has become a leading non-pharmacologic treatment for children with frequent or impairing nightmares. The topic of CBT to treat nightmares, both in childhood settings as well as in those with trauma, bipolar disorder, and narcolepsy, was the focus of a session presented at the 2025 SLEEP Annual Meeting, held June 8-11, in Seattle, Washington. Among the presenters was Lisa Cromer, PhD, a professor of psychology at the University of Tulsa, who has been studying nightmares in children for several years.

During the meeting, Cromer sat down with NeurologyLive^® to discuss her presentation, and the ways her team has adapted CBT to treat nightmares in children. Unlike a one-size-fits-all method, this 5-session treatment uses a learning theory framework to identify and disrupt the fear-avoidance cycle that maintains nightmares. In the interview, Cromer emphasized the importance of tailoring interventions to each child’s specific triggers and family dynamics while gradually building self-efficacy. She also laid out the predictable improvements in sleep patterns and nightmare distress, while highlighting the expected spike during direct exposure work, which is seen as a meaningful step toward resolution.

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