Most children experience occasional bad dreams that typically fade away by morning. For others, nightmares become a recurring problem that disrupts sleep, increases anxiety, and negatively impacts daily life. Clinicians have had limited tools specifically designed to address chronic nightmares in children.
A new theoretical study from the University of Oklahoma and the University of Tulsa introduces a new framework to address this gap. Published in Frontiers in Sleep, the research presents the DARC-NESS model, which offers a new approach to understanding why nightmares persist in children and how therapy can be designed to break this cycle.
It’s Not the Dream, It’s the Response
This new model shifts focus from the content of nightmares to the surrounding factors. The DARC-NESS approach examines how a child interprets the dream, the anxieties that develop around bedtime, and the coping strategies used after waking. The researchers suggest that it is the way children respond to nightmares, rather than the nightmares themselves, that contributes to the development of chronic sleep disturbances.
“It’s a child’s response to a nightmare that causes the chronic nightmares to happen,” said Lisa Cromer, Ph.D., a professor of psychology at the University of Tulsa and co-author of the study. “Which means if we can learn to respond to nightmares differently, then we can interrupt that cycle.”
A central concept in the model is “nightmare efficacy,” which refers to teaching children skills to address their nightmares and restore healthy sleep. According to the researchers, developing this sense of agency is both the mechanism of treatment and a key outcome.
A Customizable Treatment Approach
Children with insomnia often fear they will not be able to fall asleep, while those with chronic nightmares fear what will happen when they do. This distinction is important for determining effective treatment.
The DARC-NESS model is designed to be flexible, adapting to each child’s needs. Depending on what is driving the nightmares, treatment might focus on reducing bedtime anxiety, building better sleep routines, or using exposure-based techniques. These can include describing, writing, or drawing the nightmare, then working with a clinician to “rewrite” it or change the story. The researchers designed the model for a wide range of clinicians, including therapists, pediatricians, and sleep specialists.
“What’s unique about the model is that it’s customizable to what the patient needs, and it focuses on what the patient can control,” said Tara Buck, M.D., a child and adolescent psychiatrist at OU Health and co-author of the study. “We look for the potential intervention points and target those in a collaborative way with patients and their families.”
Beyond the Bedroom
The researchers note that the model’s benefits extend beyond improved sleep. When children gain confidence in managing their nightmares, positive effects often appear in other areas of their lives.
“Self-efficacy is at the heart of the model,” Buck said. “When children feel empowered to do something about the nightmares, they begin to see how things are interconnected — because they’re sleeping better, they have more energy, they go to school more consistently, and their parents report improved behavior.”
This broader impact highlights a gap that has existed in clinical practice. For many years, healthcare providers assumed they could not treat chronic nightmares directly or that the symptoms would resolve after addressing an underlying trauma or mental health condition. The new model challenges these previous assumptions.
“We’ve worked with children who have been in mental health treatment for a long time, and their nightmares are still persistent,” Buck said. “There is a need for a nightmare treatment model to help children when their nightmares are recurrent and distressing.”
Empowering Kids to Master Their Dreams
The DARC-NESS model is notable for its emphasis on actions children can take, rather than focusing solely on what is happening to them. The model aims to restore a sense of control by reframing chronic nightmares as something children can address. For children whose sleep, schooling, and sense of security are disrupted by chronic nightmares, this reframing may be a critical starting point for effective treatment.
“It’s empowering to understand that we can take steps to master our dreams,” Cromer concluded.
Austin Burgess is a writer and researcher with a background in sales, marketing, and data analytics. He holds an MBA, a Bachelor of Science in Business Administration, and a data analytics certification. His work focuses on breaking scientific developments, with an emphasis on emerging biology, cognitive neuroscience, and archaeological discoveries.