Theses and Dissertations

Issuing Body

Mississippi State University


Nadorff, Michael R.

Committee Member

Winer, E. Samuel

Committee Member

DeShong, Hilary L.

Committee Member

Stafford, Emily S. H.

Committee Member

Germain, Anne

Date of Degree


Original embargo terms

Visible MSU Only 3 Years

Document Type

Dissertation - Campus Access Only



Degree Name

Doctor of Philosophy


College of Arts and Sciences


Department of Psychology


Sleep concerns are prevalent and can have a detrimental impact on the overall functioning of an individual. Nightmares, specifically, have been tied to a myriad of adverse mental health outcomes and are known to exacerbate other medical/mental health symptoms. Further, nightmares appear to persist after treatment of other concerns such as posttraumatic stress, depression, and anxiety. Although many treatments exist for nightmare disorder and posttraumatic nightmares, only Imagery Rehearsal Therapy has continuously been cited as first line treatment (Morgenthaler et al., 2018). Mobile health (mHealth) technology has emerged as a viable avenue for exploration in the mental health field as technological advances are becoming commonplace in integration of clinical practice to increase accessibility. Research suggests that using mobile modalities may be a feasible way to provide sleep interventions; however, research has yet to fully explore this possibility. This project assessed a mobile application called Dream EZ released by the National Center for Telehealth and Technology, which is based on Imagery Rehearsal Therapy, but has yet to conduct research on its effectiveness. The primary purposes of this project were to (1) explore the effectiveness of smartphone-based mHealth application treatment (Dream EZ) in reduction of psychological symptoms as compared to waitlist control and (2) evaluate adherence and acceptability of treatment via smartphone application. Findings from the study support use of mHealth nightmare treatment for nightmares distress reduction (main effect: p =.010, d = .53; interaction: p =.145, d = .30). Results regarding effectiveness of mHealth treatment were inconclusive as analyses were underpowered in relation to reduction of PTSD symptoms (main effect: p =.415, d = .17; interaction: p = .262, d = .23) and suicidality (main effect: p =.007, d = .57; interaction: p =.758, d = .07). Treatment adherence and acceptability were not significantly associated with nightmare symptom reduction. Although some hypotheses were underpowered, the strength of this study laid in its use of a randomized control trial hybrid-2 study design and its timely look at viability of technology use in clinical treatment. Future directions include replication within a clinical population and in various settings such as primary care clinics.