Nightmare

Not to be confused with Night terror. For other uses, see Nightmare (disambiguation).

A nightmare (night + mare) is an unpleasant dream that can cause a strong negative emotional response from the mind, typically fear or horror, but also despair, anxiety and great sadness. The dream may contain situations of danger, discomfort, psychological or physical terror. Sufferers usually awaken in a state of distress and may be unable to return to sleep for a prolonged period of time.[1]

Contents

Overview

Nightmares can have physical causes such as sleeping in an uncomfortable or awkward position, having a fever, or psychological causes such as stress and anxiety. Eating before going to sleep, which triggers an increase in the body's metabolism and brain activity, is a potential stimulus for nightmares.[2]

Recurrent nightmares that can interfere with sleeping patterns and cause insomnia may require medical help. Recurring post-traumatic stress disorder nightmares in which real traumas are re-experienced respond best to a technique called imagery rehearsal. First described in the 1996 book Trauma and Dreams[3] by Harvard psychologist Deirdre Barrett, imagery rehearsal therapy involves the dreamer coming up with an alternate, mastery outcome to the nightmare, mentally rehearsing that outcome awake, and then reminding themselves at bedtime that they wish this alternate outcome should the nightmare recur. Research has found that this technique not only reduces the occurrence of nightmares and insomnia,[4] but also improves other daytime PTSD symptoms.[5]

Medical investigation

Studies of dreams have estimated that about 75% of dream content or emotions are negative.[6]

Two definitions of "nightmare" is a dream which causes one to wake up in the middle of the sleep cycle and experience a negative emotion, such as fear. This type of event occurs on average once per month. They are not common in children under 5, but they are more common in young children (25% experiencing a nightmare at least once per week), most common in teenagers, and less common in adults (dropping in frequency about one third from age 25 to 55).[6]

Fearfulness in waking life is correlated with the incidence of nightmares.[6]

Recognition of nightmares

Several people have received help and insight by learning about universal nightmare and anxiety dream themes which they are also experiencing.[7] Before treating one’s dream disorder, it is helpful to recognize what category the recurring dream falls into, and what it might be caused by. Here are some of the most common themes (with positive examples of dream outcomes for each scenario) and suggestions about what the dreamer might look for in waking life:

Nightmare themes

  • Chase or attack: The pursuer usually represents the dreamer’s unresolved fearfulness. The pursuer acts as an exaggerated version of an inhibited part of the dreamer’s personality that would otherwise benefit him/her if integrated and appropriately expressed.
Ideal outcome: The dreamer learns to stand his/her ground by facing and dialoguing with the pursuer; eventually, he/she will accept and overcome the original fear.
  • Falling dream: Represents the feeling of being burdened, unsupported, and worried about something. The dreamer may ask, “How can I feel freer or lighter?” Also, “Do I need to be more grounded?”
Ideal outcome: Feelings of safety; landing, floating, or flying away in the dream.
  • Car out of control: Life is too hectic and out of control. The dreamer may wonder how he/she can slow down, act more peacefully, and "enjoy the ride". Perhaps there is an important choice (i.e. turn) coming up soon in the dreamer’s life where he/she will need to slow down in order to turn safely in the best direction.
Ideal outcome: Driving well & within speed limits, walking peacefully, taking more quiet time to clearly contemplate important upcoming choices so that one doesn't go off track or crash.
  • Unprepared or late for an exam: Is the dreamer feeling unprepared for some upcoming event or deadline, or is he/she lacking confidence about a performance? Is the worry needless, or does the dreamer actually need more preparation in order to feel confident and do a good job?
Ideal outcome: Feeling assured about oneself, performing well, making sure to schedule wisely in order to peacefully meet a deadline.
  • Stuck in slow motion, unable to move or make any noise: Where does the dreamer feel stuck in life, or like he/she is getting nowhere and can’t voice his/her true feelings? Think about what can be done to change this.
Ideal outcome: Relaxation and acceptance, and eventually peaceful action & self-expression.
  • Embarrassed to be nude or scantily dressed in public, though nobody seems to really notice or mind: This type of dream may be a side-effect of personal embarrassment, perhaps because the dreamer has low confidence or fear that they have very few skills. It is usually pointing out, by the fact that the other dream characters don’t notice, that the dreamer is the only one viewing himself/herself that way, and usually mistakenly so.
Ideal outcome: The dreamer is comfortable with himself/herself as is, and is confident.
  • Personal injury, dismemberment: What part of the dreamer’s life—not usually the physical body—has he/she been neglecting, mistreating, or forgetting? (I.e. dismembering as opposed to remembering.)
Ideal outcome: Healing.
  • Trapped, locked in: The dreamer may feel trapped somewhere in his/her life. How might he/she become open to a new perspective, and explore new courses of action?
Ideal outcome: Breaking out, exploring new rooms or places.
  • Drowning, threatening waves, tsunami (tidal waves) or flooding: Is the dreamer blocking, denying, or feeling overwhelmed by emotions? They should consider how they might better acknowledge and accept these feelings, which often include vulnerability.
Ideal outcome: Swimming, surfing, and/or breathing underwater.
  • Helpless, abandoned, or with a crying baby or animal: Has the dreamer been taking care of his/her "inner child"? Perhaps there is a creative project or relationship that he/she has forgotten or abandoned that needs attention. The dreamer should try to laugh more, play outdoors, express creativity, be more spontaneous, and/or enjoy more personal warmth and intimacy.
Ideal outcome: Caring for the baby or animal, playing, and simply having more fun.[7]

Treatment

Both Freud and Jung seemed to have shared a common understanding that people frequently distressed by nightmares could be re-experiencing some stressful event from the past.[8] Both perspectives on dreams suggest that therapy can provide relief from the dilemma of the nightmare experience.

Treatment theories

Halliday (1987) grouped treatment techniques into four classes. Direct nightmare interventions that combine compatible techniques from one or more of these classes may enhance overall treatment effectiveness:[9]

Other treatment techniques

Under the overview section of the Nightmare page, there is a broad description of this therapy. According to Bret Moore and Barry Krakow, the most common variations of Imagery Rehearsal Therapy (IRT) "relate to the number of sessions, duration of treatment, and the degree to which exposure therapy is included in the protocol".[10]

"A comprehensive model has been put forth by Krakow and Zadra (2006) that includes four group treatment sessions, ~2.25 to 2.5 hr in length. The first two sessions focus on how nightmares are closely connected to insomnia and how they become an independent symptom or disorder that warrants individually tailored and targeted intervention. The last two sessions focus on the imagery system and how IRT can reshape and eliminate nightmares through a relatively straightforward process akin to cognitive restructuring via the human imagery system. First, the patient is asked to select a nightmare, but for learning purposes the choice would not typically be one that causes a marked degree of distress. Second, and most commonly, guidance is not provided on how to change the disturbing content of the dream; the specific instruction developed by Joseph Neidhardt is “change the nightmare anyway you wish” (Neidhardt et al., 1992). In turn, this step creates a “new” or “different” dream, which may or may not be free of distressing elements. Our instructions, unequivocally, do not make a suggestion to the patient to make the dream less distressing or more positive or to do anything other than “change the nightmare anyway you wish.” Last, the patient is instructed to rehearse the “new dream” through imagery and to ignore the old nightmare."[11]

Examples from literature

There are several examples from literature of characters who have dealt with nightmares and have had to overcome them. Here are just a few.

Harry Potter and the Order of the Phoenix: When Harry sleeps, there are nights when his dreams are infiltrated by the thoughts and feelings of Lord Voldemort. In order to deal with these nightmares, Harry has to take Occlumency lessons from Professor Snape, in which he learns to block his mind from Lord Voldemort.[12] In a way, this method of recovery can be likened to desensitization.
The Hunger Games: After the conclusion of the Hunger Games, Katniss Everdeen and Peeta Mellark have recurring nightmares of their days in the arena. The best way for Katniss to cope with the stress and to be able to sleep is to have Peeta comfort her.[13]
There's A Nightmare in my Closet: In the most literal sense, the boy in this story is visited by a recurring "nightmare", a monster who stays in his closet. He deals with the "nightmare" by facing his fears one night and realizing that the monster isn't as bad as he seemed.[14]

Further reading

See also

References

  1. ^ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed, TR, p. 631
  2. ^ Stephens, Laura (2006). "Nightmares :)". Http://web.archive.org/web/20070831193305/http://www.psychologytoday.com/conditions/nightmare.html. 
  3. ^ Barrett, Deirdre. (Ed.) Trauma and Dreams. Cambridge, MA: Harvard University Press, 1996.
  4. ^ Davis JL, Wright DC (2005). "Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress". Behavioral sleep medicine 3 (3): 151–157. doi:10.1207/s15402010bsm0303_3. PMID 15984916. 
  5. ^ Krakow B, Hollifield M, Johnston L et al. (2001). "Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with post traumatic stress disorder: a randomized controlled trial.". JAMA 286 (5): 537–545. doi:10.1001/jama.286.5.537. PMID 11476655. 
  6. ^ a b c The Science Behind Dreams and Nightmares, Talk of the Nation, national Public Radio. 30 October 2007.
  7. ^ a b Dreams Foundation 1996, Web
  8. ^ Coalson 1985, Web
  9. ^ Halliday 1987
  10. ^ Moore 2010, p. 234
  11. ^ "Moore 2010, p. 234"
  12. ^ Rowling 2003
  13. ^ Collins 2008
  14. ^ Mayer 1976

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