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Trauma Nightmares and Mental Health: Realistic Dreams a Key Warning Sign

A veteran who dreams about being back in the thick of an intense battle, or a car accident victim who repeatedly wakes up from a nightmare just before what feels like a potentially fatal impact… dreams that create vivid and direct experience of someone’s most traumatic memories are clinical red flags. A new study offers even more support for us to take such dreams seriously.

We already know that nightmares about traumatic events are in a category of their own: they are linked to both PTSD and higher suicide risk. In a recent study (Richards et al. 2025) which examines how nightmares relate to mental health outcomes, one factor emerged as particularly significant: the replicative quality of trauma nightmares. Those who work with trauma should make a habit of asking how closely nightmare content matches the actual traumatic event, and pay particular attention to dreams that feel like an exact replay of terrifying memories.

The notion that replicative dreams indicate unprocessed trauma is not new – dream researchers have already noted that when dreams move along the continuum from real-life replay to more dreamlike and unrealistic, this is an indication of trauma recovery. This latest study strongly supports what we already know and also tests a new data collection method for researchers.

 

The Study

A research team at UCSF and the San Francisco VA Medical Center studied 103 trauma-exposed adults who experienced at least one nightmare per week. Using a custom designed mobile app, participants logged their nightmare experiences over three weeks, rating various characteristics including how closely their dreams replicated their actual trauma experiences. The results revealed compelling patterns that could help clinicians better assess and respond to nightmare-related distress.

While several nightmare characteristics were associated with negative outcomes, the replicative nature of trauma nightmares stood out as uniquely predictive of suicidal ideation, even when controlling for depression. This suggests that when patients report dreams that closely mirror their traumatic experiences, clinicians should be particularly alert to potential suicide risk.

 

What makes this finding significant for clinical practice?

Not all trauma nightmares are created equal. In Richards’ study, the characteristics of participant nightmares varied considerably. Some were only loosely connected to trauma through emotional resonance, while others replayed traumatic events in vivid detail. This variation proved meaningful – the more closely a nightmare replicated the actual trauma, the stronger its association with negative outcomes.

The researchers found that different nightmare characteristics predicted different clinical concerns. For instance, nightmare duration and post-dream arousal (difficulty returning to sleep) were strongly linked to next-day mood disturbance. However, replicative quality emerged as the strongest predictor of both PTSD symptom severity and suicidal ideation. Every instance of reported active suicidal ideation came from participants with PTSD.

This pattern makes intuitive sense when we consider the nature of trauma processing. Dreams that exactly replay traumatic events may represent a failure of the natural dream process to integrate and metabolize traumatic memories. Instead of the typical dream-like transformation of daily experiences, the contents of replicative nightmares remain raw and unprocessed. Rather than being incorporated into the associative web of normal memory, these unmetabolized events have an always-current quality that can create a sense of despair in those who experience them.

For clinicians, these findings point to the importance of carefully assessing nightmare content, not just frequency or intensity. When working with trauma survivors who experience nightmares, consider asking:

– How similar are the nightmares to the actual traumatic event(s)?

– Do they replay the trauma exactly, or are elements changed/symbolic?

– Has the content of trauma nightmares evolved over time?

 

We May Need to Broaden Our Clinical Definition of Nightmares

The study revealed that only about 17-18% of reported distressing dreams met the full diagnostic criteria for nightmares as defined in DSM-5 (awakening with full alertness and detailed recall). This suggests we may need to broaden our clinical attention beyond classical nightmares to include other forms of trauma-related disturbing dreams. In my practice, I treat client dreams as nightmares if they experience them as such, and I do not insist on the awakening criteria.

Why might highly replicative nightmares be especially concerning? One theory is that they represent a particularly devastating form of re-traumatization. Unlike daytime intrusive memories, which patients can often manage with learned coping strategies, nightmares strike when we are least able to employ conscious coping methods. The exact replay of trauma during sleep may intensify feelings of helplessness and hopelessness.

 

Mobile App Simplifies Data Collection

The study’s findings also highlight the promise of mobile technology in nightmare assessment. The app-based sleep diary yielded rich data about nightmare characteristics with high temporal precision. This suggests that similar tools could help clinicians track nightmare patterns and evolution during treatment.

For clinicians working with trauma survivors, this research underscores the importance of detailed nightmare assessment as part of routine care. Beyond simply asking about nightmare frequency or distress, exploring the replicative quality of nightmares may provide crucial clinical insights and help guide treatment planning and risk assessment. When it comes to trauma nightmares, content matters and dreams that closely mirror traumatic experiences need to be treated.

 

Richards, A., Santistevan, A., Kovnick, M., Orlova, P., Yack, L., Berg, E., Pracar, S., Metzler, T., Neylan, T., & Woodward, S. (2025). Distressing Dreams in Trauma Survivors: Using a sleep diary mobile app to reveal distressing dream characteristics and their relationship to symptoms and suicidal ideation in trauma-exposed adults. Sleep Advances. Advance online publication. https://doi.org/10.1093/sleepadvances/zpae099

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Living in the Mind’s Darkness: Understanding Aphantasia

In my work is an experiential and dream therapist, I often invite my clients to enter their dreams, allowing their nocturnal imagery to re-form in their mind’s eye. Most people I ask can do this quite easily, and some produce a virtual torrent of imagery. But not everyone can, and I used to think of this as an ability that varies but can be developed. What I have recently discovered is that there are some people born without the ability to visualize memories, imaginary scenes or future scenarios. Interestingly, this condition, called aphantasia, does not prevent people from dreaming, but their ability to voluntarily bring images to mind is absent.

Do you have aphantasia? When you close your eyes and try to picture a sunset, what do you see? For most of us, a mental canvas springs to life – gorgeous hues of glowing red and orange spread across the horizon. But for roughly 2-5% of the population, this simple act of visualization is impossible. For those with aphantasia, the mind’s eye is effectively blind. And with it, some of their ability to process emotion appears to be affected as well.

One proposed function of imagery, used often by therapists, is to render memories, dreams and thoughts more emotionally evocative through sensory simulation. Wicken and colleages (2019) tested this theory using aphantasics. “After using multi-method verification of aphantasia, we show that this condition, but not the general population, is associated with a flat-line physiological response to frightening written, but not perceptual scenarios.” This finding supports imagery’s critical role in evoking and processing emotion.

 

Aphantasia: A broad spectrum

The term aphantasia was coined by cognitive neurologist Professor Adam Zeman in 2015. Zeman (2024) places the vividness of ability to create internal imagery on a spectrum – from those who have no ability to visualize to those who experience hyperphantasia, an unusual abundance of mental imagery. He notes increasing evidence that aphantasics have some distinctive traits such as reduced autobiographical memory and face recognition, a greater interest in scientific occupations, and a greater propensity for autism. He suggests variation in neural connectivity may be the cause. Interestingly, those with aphantasia still experience dream imagery – possibly because our nocturnal imaginings are largely involuntary.

Zeman wrote: “Despite the profound contrast in subjective experience between aphantasia and hyperphantasia, the effects on everyday functioning are subtle – lack of imagery does not imply lack of imagination.”

 

Picture a safe place…

Meet Sarah (name changed), an architect who discovered her aphantasia during a particularly awkward moment in therapy. “My therapist asked me to close my eyes and picture my safe place. I sat there for what felt like an eternity, trying to explain that while I understood the concept of creating the image of a warm, protected place, I couldn’t actually ‘see’ one. She thought I was being resistant to the treatment. That’s when I realized I was different from most people.”

The irony of an architect who can’t visualize buildings isn’t lost on Sarah. “People assume I must be in the wrong profession, but I’ve developed other ways to think about space and design. I work with physical models and CAD software. My inability to visualize actually makes me more methodical and precise in my approach.” This notion is supported by research that shows visual working memory tasks are not impaired in those with aphantasia, they simpy use different strategies to work through questions most of us would visualize.

 

Causes unclear, but treatment not necessary

The scientific community is still unraveling the many outstanding mysteries of aphantasia. It appears to be linked to reduced connectivity between the frontal and visual networks in the brain. But the cause of this disconnection is not clear. Most cases appear to be congenital, while others develop after trauma or injury. Dr. Rebecca Keogh’s (2018) research at the University of New South Wales suggests there might be a genetic component, though the inheritance pattern remains unclear.

The condition exists on a spectrum. Some aphantasics report complete inability to generate any sensory imagery – not just visual, but auditory, olfactory, and tactile as well. Others might have partial imagery abilities or can experience involuntary images in dreams, despite being unable to consciously conjure them while awake.

Currently, there is no established treatment for aphantasia, primarily because it’s not classified as a disorder or disability. Aphantasics excel in fields from science to literature. For example Craig Venter, one of the first scientists to sequence the human genome, is aphantasic. His inability to visualize didn’t prevent him from making groundbreaking scientific discoveries.

The discovery of aphantasia has sparked fascinating philosophical questions about consciousness, creativity, and the nature of thought itself. How essential is mental imagery to human experience? Can abstract thinking compensate for the lack of visual imagination? These questions are driving new research in cognitive science and challenging our assumptions about how the mind works.

Perhaps the most intriguing aspect of aphantasia is how it remained largely unrecognized until recently. People with aphantasia often assume everyone experiences thought the same way they do – through conceptual understanding rather than mental imagery. It’s like discovering that while you’ve been watching a black and white TV all your life, others have been watching in color. For those curious about their own visualization abilities, researchers have developed various assessment tools, including the VVIQ (Vividness of Visual Imagery Questionnaire). However, measuring something as subjective as mental imagery remains challenging.

As we advance our knowledge of aphantasia, the focus shouldn’t be on “fixing” what isn’t broken, but rather on understanding and accommodating different ways of thinking. Sarah puts it eloquently: “Having aphantasia isn’t like missing a limb – it’s more like being left-handed in a right-handed world. Once you figure out your own way of doing things, it stops being an obstacle and becomes just another part of who you are.”

 

References:

Arcangeli, M. (2023). Aphantasia demystified. Synthese201(2), 31.

Blomkvist, A., & Marks, D. F. (2023). Defining and ‘diagnosing’aphantasia: Condition or individual difference? Cortex169, 220-234.

Blomkvist, A. (2023). Aphantasia: In search of a theory. Mind & Language38(3), 866-888.

Dance, C. J., Ipser, A., & Simner, J. (2022). The prevalence of aphantasia (imagery weakness) in the general population. Consciousness and Cognition97, 103243.

Dawes, A. J., Keogh, R., Andrillon, T., & Pearson, J. (2020). A cognitive profile of multi-sensory imagery, memory and dreaming in aphantasia. Scientific reports10(1), 10022.

Keogh, R., & Pearson, J. (2018). The blind mind: No sensory visual imagery in aphantasia. Cortex, 105, 53-60.

McKelvie, S. J. (1995). The VVIQ and beyond: Vividness and its measurement.

Whiteley, C. M. (2021). Aphantasia, imagination and dreaming. Philosophical Studies178(6), 2111-2132.Wicken, M., Keogh, R., & Pearson, J. (2019). The critical role of mental imagery in human emotion: Insights from aphantasia. biorxiv, 726844.

Zeman, A., Dewar, M., & Della Sala, S. (2015). Lives without imagery – Congenital aphantasia. Cortex, 73, 378-380.

Zeman, A. (2024). Aphantasia and hyperphantasia: exploring imagery vividness extremes. Trends in Cognitive Sciences.

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Peering Into the ‘Black Box’ of Dreaming

How Technology is Making Our Dream Worlds More Accessible and Malleable

One aspect of dreams that makes them so mysterious is that they are notoriously difficult to study. While those who dream vividly or lucidly can accurately report their detailed dream content, most of us imperfectly capture fragments of our dreams and are left with a sense that there was so much more in our dream than we could capture. The longer we wait to document a dream, the more distorted and incomplete the dream report is likely to be.

As someone who works with dreams in clinical practice, this is not necessarily a problem. I have found that the most striking dream elements, those that break through sleep and enter consciousness, are often the most important dream events to process in sessions. Forgetting is like a natural editing process. Those with high recall who dream frequently and vividly tend to have too much material, and it can be overwhelming to sort through it all. Interestingly, when we do experiential dreamwork with highly active dreamers, their dream lives tend to quiet down – possibly because as we re-enter and metabolize dreams while awake, there is less emotional processing needed at night.

But I digress… while dream clinicians are less concerned about how closely dream reports reflect actual dreams, those who study dreams themselves really do need completeness and accuracy. Researchers have tried many ways to open up the ‘black box’ of dreaming, and with the help of a confluence of technologies, they are starting to have success.

In a review article, Remy Mallett and colleagues (2024) describe the most important current advancements for capturing, manipulating and studying dreams. Some of these ideas may apply clinically as well, especially for those who want to recall more dreams or learn how to change their dream content (more on this later). The article states, “these innovations herald a new era in dream science.” The review identifies three main areas of advancement that, taken together, are helping dream researchers to move beyond the limitations of subjective post-sleep reports to embrace more objective and scientifically rigorous approaches.

New Ways to Observe Dreams in Real Time

The first is observable dreaming, which represents a significant breakthrough in our ability to “witness” dreams as they occur. Through neural decoding techniques, researchers can now identify dream content by analyzing brain activity patterns. This approach is complemented by real-time reporting through lucid dreaming, enabling direct communication with dreamers during their dream experiences. As well, physiological measures such as eye movements and muscle activity are providing valuable insights into dream content, offering objective markers of subjective experiences.

Engineering Changes in Dreams While Dreaming

Dream engineering, the second major advance, introduces methods to actively influence and shape dream content. Through sensory stimulation during sleep, researchers can now guide dream narratives in specific directions. Targeted Memory Reactivation (TMR) has emerged as one promising technique, allowing for the strategic activation of specific memories or associations during sleep to influence dream content. For example, a recent study was able to use sound to enhance the effects of Imagery Rehearsal Therapy (IRT) – which basically involves rescripting the ending of nightmares. The reseachers paired piano chords with the dreamer’s imagined new dream ending, then played it back during the dreaming phases of sleep, and this improved the results of IRT (Schwartz et al., 2022).

Lucid dreaming serves as another powerful tool for dream manipulation, enabling participants to consciously direct their dream experiences. There has been increasing success in using technology to prompt lucid dreaming, a process called Targeted Lucidity Reactivation. The process includes pre-sleep conditioning to create a ‘lucidity mindset,’ a state of mind in which one is more likely to question the nature of their experience and ask, am I dreaming? When a sound associated with this mindset is played during REM/dream sleep, lucidity is triggered more often, even in novice lucid dreamers. Recently, this process was tailored for at home use via a phone app, and the results were impressive – tripling the incidence of lucidity in participants.

Analysis of Large Dream Databases

The third breakthrough comes in the form of computational analysis, which is transforming how we process and understand dream data. Big data approaches are revealing previously undetectable patterns in large collections of dream reports. Natural language processing tools are automating the analysis of dream content, making it possible to process vast amounts of dream narratives efficiently and systematically. Network analysis of dream reports has shown particular promise in clinical applications, potentially aiding in the diagnosis and treatment of various psychological conditions.

Clinical Applications

These advances offer strong potential for therapeutic applications. The article discusses particularly promising developments in the treatment of nightmares and PTSD. By combining traditional approaches like Imagery Rehearsal Therapy with dream engineering techniques, clinicians may have more effective tools for addressing sleep-related psychological distress. The ability to influence dream content directly could revolutionize how we approach trauma-related sleep disturbances and other dream-related psychological challenges.

What makes these advances particularly exciting is their complementary nature. While dream engineering provides tools for manipulating dream content, computational analysis helps us understand the patterns that emerge from these manipulations, and observable dreaming techniques offer ways to validate findings. This triangulation of methods strengthens the scientific validity of dream research and opens new avenues for understanding the relationship between dreaming and psychological well-being.

Challenges and Caveats

Several significant challenges remain in the field. The reliability of lucid dream induction remains inconsistent, limiting the broader applicability of this technique. Questions persist about whether findings from lucid dream research can be generalized to non-lucid dreams, which represent the majority of dream experiences. Current technology, while advancing rapidly, still has precision limitations that affect the ability to decode and influence dream content with high accuracy. Additionally, there are ongoing discussions about how best to assess dream incorporation – that is, how to measure the extent to which specific elements appear in dreams.

Looking forward, the field appears poised for further advances, spurred by the development of more sophisticated neural decoding techniques, improved methods for dream manipulation, and more powerful computational tools. While this is excellent for deepening the understanding of dreaming, I wonder how much manipulation of our dreams is truly helpful – or if the resulting dreams truly represent dreaming in its ‘wild’ state.

Are Hybrid States Authentic Dreaming?

When something like waking consciousness is added to dreaming, and we are aware of and able to manipulate our dream content, what results is a hybrid state of consciousness that is no longer natural dreaming. As someone who appreciates the healing power of dreams, even the intense ones, I have some concern about processes that shift the dream into something more palateable, possibly skipping the very processes the dream is trying to engender.

When I expressed this concern to Mallet, the article’s lead author, he said he tends to agree: everything in moderation. There is clearly a balance to be struck here, because anything that provides nightmare sufferers with some relief and restful sleep is a good thing.

Still, just because we can manipulate or become lucid in our dreams does not mean we should always do so. A study hot off the press (Carr et al., 2024) shows that caution and more information is needed. The researchers surveyed 1332 people about their dreams and mental health symptoms and found that the interaction between nightmares and lucid dreaming was a significant predictor of depressive symptoms. They also found that lucid dreaming predicts poor sleep quality, stress and anxiety, but that these latter symptoms could be accounted for by nightmares alone.

With a mix of caution and optimism, I welcome the advances researchers are making to better understand dreams. The pace of technological change is brisk, and it’s exciting to see the various new avenues it allows the study of dreams to take. So much of value can be learned. However, I am dubious about the prospect of opening up and altering our dream worlds too much – they are private, deep nocturnal experiences that have something of a wild nature I am reluctant to fully capture and tame.

 

References

Carr, M., Youngren, W., Seehuus, M., Semin, R., Angle, E., & Pigeon, W. R. (2024). The Effects of Lucid Dreaming and Nightmares on Sleep Quality and Mental Health Outcomes. Behavioral Sleep Medicine, 1-8.

Konkoly, K. R., Whitmore, N. W., Mallett, R., Mazurek, C. Y., & Paller, K. A. (2024). Provoking lucid dreams at home with sensory cues paired with pre-sleep cognitive training. Consciousness and Cognition125, 103759.

Mallett, R., Konkoly, K. R., Nielsen, T., Carr, M., & Paller, K. A. (2024). New strategies for the cognitive science of dreaming. Trends in Cognitive Sciences.

Schwartz, S., Clerget, A., & Perogamvros, L. (2022). Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Current Biology32(22), 4808-4816.

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Why We Forget Our Dreams: A New Perspective

One of the most enduring paradoxes in the field of dream research is the mystery of dream amnesia. Why do we forget most of our dreams, even though they’re often vivid, emotionally charged, and potentially important for our survival? A recent paper by Zhao and colleagues offers an elegant solution to this puzzle.

Here’s the conundrum: Many scientists believe dreams serve crucial biological functions, helping us rehearse responses to threats and practice social interactions. These experiences can be incredibly vivid and emotionally intense – yet most of us can barely remember our dreams unless we wake up right in the middle of one. This seems counterintuitive. If dreams are so important, shouldn’t we remember them clearly?

The answer lies in understanding how different types of memory work in our brains. The researchers propose that forgetting our dreams isn’t a bug – it’s a feature. Here’s why: If we retained vivid memories of our dreams, we might confuse them with real experiences. Imagine having a heated argument with your partner in a dream and waking up angry at them for something that never actually happened. Not ideal, right?

But here’s the clever part – while we may forget the specific content of our dreams, the skills and behaviors we practice during them can still benefit us. Think about it like learning to ride a bike: you don’t need to remember every practice session to maintain the skill. Similarly, when we rehearse dealing with threats or social situations in our dreams, our brains can retain the practical lessons without keeping the specific dream memories.

This explains why dream amnesia makes sense from an evolutionary perspective. Our brains suppress the explicit, narrative memories of dreams to avoid confusion with real events, while preserving the implicit learning and skill development that occurred during the dream.

The system isn’t perfect – sometimes dreams do break through this forgetting mechanism, particularly when they’re highly emotional or frightening — most nightmares are easily recalled for example. But biological systems don’t need to work perfectly to be beneficial. The key is that dream amnesia helps us maintain a clear distinction between our dreaming and waking experiences while still allowing us to benefit from the practice and learning that occurs during our dreams. This group of reseachers are clear proponents of the idea that a major purpose of dreams is simulation. Other possible functions include memory consolidation, emotion processing and creative inspiration.

This new way of explaining dream amnesia provides a fresh perspective on the value of our forgotten dreams. Even though we may not remember them, our nightly adventures may continue to shape our skills and behaviors in subtle but important ways. So the next time you wake up with only fragments of a dream remaining, don’t worry about having lost the details. Possibly, as Zhao and collegaues suggest, the benefits of your dream experiences stay with you long after the memories fade.

 

Zhao, J., Schoch, S. F., Valli, K., & Dresler, M. (2024). Dream function and dream amnesia: dissolution of an apparent paradox. Neuroscience and biobehavioral reviews, 105951.

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Influencing Dream Content and Creativity

Fascinating new research that confirms what creative minds like Salvador Dalí and Thomas Edison intuited long ago – the drowsy period as we drift off to sleep can supercharge our creative abilities. Researchers from MIT and Harvard (Horowitz et al., 2020, 2023) demonstrated that deliberately influencing dreams during sleep onset (known as N1 sleep or hypnagogia) can significantly boost creative thinking.

Using a sensor-laden glove called Dormio, that detects when people enter this generative sleep stage, the team conducted an targeted dream incubation (TDI) experiment in which they prompted participants think about trees as they dozed off. The results were remarkable. People who had tree-related dreams during sleep onset performed far better on subsequent creativity tests compared to those who stayed awake or slept without the tree suggestion. Even more intriguingly, the more that participants incorporated trees into their drowsy dreams, the more creative their later responses became.

In the hypnagogic state, our usual mental boundaries become more permeable and fluid, allowing novel ideas and strange combinations of thoughts to emerge. The research has shown that our minds naturally make broader, more distant connections between concepts during sleep onset. What is significant about this study is that it’s the first to demonstrate a direct causal link between specific dream content and enhanced creativity. Previous research has demonstrated that sleep boosts creative problem-solving, but this study shows that we can actually guide our dreams to offer creative new ideas and solutions in specific areas of inquiry.

The implications are exciting. The study shows what many of us dream afficionados already understand – that it’s possible to harness your sleep onset period to enhance creative thinking around specific questions. While more research is needed to fully understand how long these effects last and how they might apply to different types of problems, this study lends credence to the idea that ‘sleeping on it’ really does help us find solutions not available to our waking minds.

For those interested in experimenting with this yourself, the key period is that drowsy state just as you’re falling asleep. While you may not have access to the Dormio device, simply holding a specific problem or theme in mind as you drift off could spark creative insights. Dormio detects alterations in sleep states and offers timely prompts to capture a whole series of pre-sleep dream images. It then records verbal N1 dream reports immediately. If we wait until morning to write our liminal reams down, most of these early images will be forgotten. So taking a cue from this research, try using a smartphone to record verbal dream reports as soon as you are awake enough to become aware of them. You may find you record many dreams throughout the night, not only in sleep onset, and develop a fuller picture of your creative dreaming mind.

Dali and Edison were known to deliberately harness the dreams from sleep onset by napping in a chair with an object in their hands that would clatter to the floor as soon as the muscle relaxation in early sleep released the object. The noise would wake them up and they would then record dreams that became fodder for inventions for Edison and surreal images for Dali.

The next frontier in creativity research may well be in understanding how to better utilize these unique states of consciousness that we all experience every night. As this study shows, our dreams might hold more practical value than we ever imagined.

What are your experiences with creative insights during sleep onset? I’d love to hear about them in the comments below.

The paper describes Dormio, a novel device designed to study and influence dream content during the hypnagogic period (sleep onset). The device uses sensors to detect when users are falling asleep and delivers targeted audio prompts to influence dream content, a process called targeted dream incubation (TDI).

The researchers conducted a study with 49 participants divided into sleep and wake conditions, with and without prompting to think about “trees.” The Dormio device monitored heart rate, finger muscle tension, and electrodermal activity to detect sleep onset. When sleep was detected, the device would wake participants and ask them to report their mental experiences before providing new prompts.

Key findings:

  • 67% of prompted sleep condition reports contained references to trees
  • Only 3% of unprompted sleep condition reports mentioned trees
  • 52% of prompted wake condition reports mentioned trees
  • 0% of unprompted wake condition reports mentioned trees

The device successfully demonstrated its ability to influence dream content during sleep onset. Dream reports showed increasing bizarreness and immersion with subsequent awakenings, while maintaining the targeted theme.

The research builds on previous studies showing that dream content can predict post-sleep memory enhancement and that sensory input during sleep can influence memory consolidation. While other techniques like Targeted Memory Reactivation (TMR) have shown that presenting sensory cues during sleep can enhance memory consolidation, Dormio provides a way to study the subjective experience of memory processing during sleep.

The researchers suggest several potential applications for Dormio and TDI:

  • Studying the causal relationship between dream content and memory consolidation
  • Enhancing creativity through directed dream experiences
  • Understanding the role of dreams in processing daily experiences
  • Investigating memory formation and integration during sleep

Limitations of the study include:

  • Limited age range of participants
  • Lack of polysomnographic validation of sleep stages
  • Reliance on subjective dream reports
  • Use of only one incubation theme (“tree”)

The researchers emphasize that while they can demonstrate correlation between dream incorporation and memory processing, they cannot yet prove whether dreaming itself causes memory consolidation or is simply a reflection of underlying processes.

The Dormio device represents a new tool for studying dreams and consciousness that is more accessible than traditional sleep lab equipment. It enables controlled manipulation of dream content, which could help answer fundamental questions about the role of dreams in memory, creativity, and cognitive processing.

The authors propose future studies using Dormio to investigate whether deliberately inducing specific dream content can enhance learning and memory consolidation, potentially opening new avenues for cognitive enhancement through dream engineering.

 

Horowitz, A. H., Cunningham, T. J., Maes, P., & Stickgold, R. (2020). Dormio: A targeted dream incubation device. Consciousness and cognition83, 102938.

Horowitz, A. H., Esfahany, K., Gálvez, T. V., Maes, P., & Stickgold, R. (2023). Targeted dream incubation at sleep onset increases post-sleep creative performance. Scientific reports13(1), 7319.

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Do Dreams Predict the Future?

I was recently asked this question by Women’s Health magazine, and it led to some interesting further reading and provocative thoughts.

An amazing half of people asked will say they had a precognitive dream at some point in their lives. Does this mean dreams can predict the future? So far, there is no scientific evidence to back this statement up – and it may be impossible to actually run such an experiment. However, there are many possible explanations which point to the nature of dreaming itself.

What researchers have found is that most precognitive dreams are retrospective, meaning we recognize them as prescient after the fact. When you do the opposite – track dreams and then see if what we dream about actually comes to pass, the instances of precognition drop dramatically. However, there are still many astounding stories of dreams predicting events that actually happen.

I was once on a radio show, and a caller told me a story about a lifelong recurrent dream: they were rounding a curve in the highway and suddenly, there was a huge slide ahead that had washed out the road. He said one day, he found himself on this familiar stretch of road, and instinctively braked before the turn. The road indeed was washed away, and he credits the dream for saving his life.

Here is a quick survey of possible explanations:

  • Dreams are future-oriented simulations that depict likely scenarios; some of them may be accurate.
  • Our bodies and our subconscious are adept at picking up subtle early cues about things that matter to us such as our health and relationships.
  • Statistically speaking, given the sheer number of dreams, it is impossible not to have precognitive dreams. (For more on this, see Matt Walker’s podcast: https://podcasts.apple.com/us/podcast/76-precognitive-dreaming/id1578319619?i=1000659367737)
  • Dreams are our connection to the wider world of psyche and operate outside the bounds of rationality and linear time.

Notice that all of these could be true, although the last item asks us to step outside of the rational, evidence-based perspective that dominates our culture.  This bias toward what is visible and measurable has demoted dreams to the sidelines (even in psychology), and yet there remains a yearning to connect with their wider wisdom. So many people I encounter wish for a deeper connection to their dreaming lives and a way to make sense of them.  I suspect this us why I am often asked questions that point to the mysterious nature of dreaming. I typically search for the answers from both within the realm of science and also from those who relate to dreams as sacred, and not bounded by what can be seen and measured.

As luck would have it, as I was writing this short post, I picked up a new book, The Dreaming Way by Toko-pa Turner. In it, she eloquently offers her perspective on the purpose of dreaming: as a bridge between physical and sacred realities, a bridge that she says has “fallen into disrepair.” When dreams are viewed as sacred communication from the imaginal realm, they are taken seriously, as pointing to one’s deeper life purpose, and potentially as prophetic. Ancient texts from many cultures (including Greek philosophy, the Bible, the Upanishads) feature accounts of important, prophetic dreams.

The biggest problem with precognitive dreams is that you don’t know they are actually predicting something until after the fact. Still, because of the ability of our subconscious mind to pick up early warning signs, I suggest acting on any dreams that seem insistent, especially if they are pointing to potentially serious issues with your health or emotional life. Many people have credited such dreams with saving their life by pointing to a malignant cancer or other serious illness.

With other dreams that seem like warnings, it’s hard to know how to respond. A friend who was about to go on a road trip dreamt of not one, but several massive car crashes. She asked if this meant she should postpone her trip (she did). However, the dream could have been a metaphor for other things: at a personal level, a loss of control, or relational conflict. At the collective level, a portent of danger or disaster?

In general, I advocate for all of us to develop a deeper relationship with our dreaming worlds. When we have a sense of the ongoing trajectory of our dreaming lives, what they are telling us or asking of us can become much clearer. Whether you adopt the rational or sacred view of dreams, or bridge them both, viewing dreams as depictions of a possible future is a valid approach that invites reflection and possible course correction.

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Psychedelic Medicine and Dreams: A conversation with Katherine Lawson

The use of psychedelic substances as therapeutic agents is a trend with great promise, and a work in progress. There is an exciting but nascent body of research on efficacy and best practices, and there remains many legal and ethical obstacles.  In the meantime, the use of plant medicines is growing like a weed – quickly, organically and not always in the most desirable way.

“It’s the wild West,” says Dr. Katherine Lawson, a pioneer in using embodied dreamwork practices to facilitate integration of psychedelic experiences. She notes that since people are using plant medicines anyway, and have been for ages, there is a need to help facilitators offer safe, constructive and respectful ways to help clients prepare for and integrate their experiences. This is why she founded Awake in the Dream School.

 

Psychedelic Therapies Show Promise

Anecdotally, Lawson has witnessed dramatic changes in her clients as a result of the use of plant medicine, and in a much shorter time frame than is typical with more traditional talk therapy. “One of the main reasons for that, is that while you are under the influence of the medicine (in this example, MDMA), you do not have much access to shame, fear and guilt. And if you are a skilled facilitator, you can help your client go back and heal things that are not approachable in normal waking consciousness, with all the layers of protective mechanisms. Those are gone. Your clients can see things so differently — from a loving, empathic perspective. That’s the gift of these medicines.”

Research backs this up and is demonstrating the efficacy of these substances in addressing conditions like depression, anxiety, PTSD, and addiction (Carhart-Harris & Goodwin, 2017; Mithoefer et al., 2018; Palhano-Fontes et al., 2019). The proposed mechanisms of action for psychedelics in therapeutic settings include their ability to reduce negative cognitive biases, enhance emotional processing, and promote neuroplasticity (Rucker et al., 2018).

Studies have shown that a single dose of psilocybin can produce rapid and sustained reductions in depressive and anxiety symptoms in patients with life-threatening cancer (Griffiths et al., 2016). MDMA-assisted psychotherapy has demonstrated promising results in the treatment of PTSD, with participants experiencing significant and lasting improvements in symptoms (Mithoefer et al., 2018). Psychedelics may also facilitate mystical-type experiences that can lead to profound personal insights and shifts in worldview, which some researchers believe can catalyze lasting positive changes in attitudes, mood, and behavior (Carhart-Harris & Goodwin, 2017).

The research on psychedelics is still in its early stages, and more large-scale, rigorous clinical trials are needed to establish their efficacy and safety profiles. The specialized nature of psychedelic-assisted therapy, which often involves extensive preparation, guidance during the experience, and integration support, can also limit accessibility and scalability.

 

Education Needed

Lawson has been working with users of plant medicine for a decade, and has learned much about the incredible potential for transformation these substances can bring about. But there is also much of concern in practices stemming from lack of knowledge, desire for a quick fix, and in the worst cases, dangerous and unethical practices. She established her school to educate mental health professionals who want to help those taking psychedelic substances to prepare for the journey and integrate the experiences afterwards. She said without these crucial pre- and post-journey steps, the experience can be no different from taking a drug trip – amazing, terrifying or anything in between.

She does not work with any of the substances directly, nor does she teach about how to administer the medicine and support the actual experiences (‘trip-sitting’). This is because so many of the substances are illegal. And yet there is a grey area, because they are also widely accessible. “The National Institute of Health (NIH) estimates 50 million Americans have interacted with these medicines since 2021, and that figure is probably very low,” according to Lawson.

 

Adapting Dreamwork for Integration

As someone who teaches embodied experiential dreamwork to therapists, I was particularly intrigued by how Dr. Lawson has adapted dreamwork techniques to support the integration of plant medicine journeys. She was one of the early providers of integration sessions via MAPS, the Multidisciplinary Association for Psychedelic Studies.

Over the past decade, Dr. Lawson has worked with hundreds of individuals navigating psychedelic experiences and has used her depth of experience to develop a training program to equip practitioners with the skills to support this process. A key distinction in her approach is the emphasis on preparation and integration, rather than facilitating the psychedelic journeys themselves. Her training, for those in the mental health and wellness industries, educates facilitators on 8 different medicines – learning what to expect and how to support clients through the experience. Lawson, said the specific substance and the nature of its use can vary so widely – from deep ceremonial practice to recreational highs. Most often, therapeutic plant medicine experiences are offered in facilitated group or one-on-one guided sessions.

The core post-session integration practice Lawson teaches is based on Embodied Imagination as developed by Dutch psychoanalyst Robert Bosnak. She has found that working with psychedelic visions requires some adaptation. “There’s an intensity to it, there’s a possession by it that’s got a different quality than a dream,” she explained. “If you guide someone back into their dream in a hypnagogic state, they always have a certain awareness of being in a dual state of consciousness. But with a psychedelic experience, for a while, they’re just in it — you can still guide them, but you might have to be more assertive, more directive.”

Another key difference, according to Dr. Lawson, is the need to be particularly mindful of scope of practice and ethical boundaries when working with clients who have had intense psychedelic experiences. “There’s a lot of people out there abusing the power imbalance that’s implicit in serving these medicines,” she said. “So we really lean into things like being trauma-informed and understanding contraindications.” Acute adverse effects can include anxiety, panic, and psychotic episodes, particularly in individuals with a history of mental health conditions (Carbonaro et al., 2016).

Overall, Dr. Lawson’s approach seems to strike an important balance — honoring the profound potential of psychedelics for healing and transformation, while also recognizing the need for skilled, ethical, and trauma-informed support. As someone who has seen the benefits of dreamwork in clinical practice, I’m intrigued by the possibilities of integrating these modalities to help clients navigate their most profound experiences.

To learn more about Awake in the Dream School and Dr. Lawson’s work, check out awakeinthedream.co  For those on my email list, Lawson has generously offered a 10% discount on her 6-month certification program if you use this code upon checkout: AWAKE-Drleslieellis

 

References

Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Emphasis on context and impairment. Journal of Psychopharmacology, 30(12), 1268-1278. https://doi.org/10.1177/0269881116662634

Garasic, M. D., & Lavazza, A. (2021). Moral and social reasons to access psychedelic-assisted psychotherapy. BMC Medical Ethics, 22(1), 1-11. https://doi.org/10.1186/s12910-021-00588-x

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., … & Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181-1197. https://doi.org/10.1177/0269881116675513

Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., … & Doblin, R. (2018). MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology, 235(11), 3137-3144. https://doi.org/10.1007/s00213-018-4988-2

Palhano-Fontes, F., Barreto, D., Onias, H., Andrade, K. C., Novaes, M. M., Pessoa, J. A., … & Araújo, D. B. (2019). Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psychological Medicine, 49(4), 655-663. https://doi.org/10.1017/S0033291718001356

Rucker, J. J., Iliff, J., & Nutt, D. J. (2018). Psychiatry & the psychedelic drugs. Past, present & future. Neuropharmacology, 142, 200-218. https://doi.org/10.1016/j.neuropharm.2017.12.040

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Become An Exquisite Listening Partner with Focusing

Are you interested in deepening your ability to listen in a way that enables another person to touch into their body’s wisdom? Whether you are a mental health professional, partner, coach, parent, friend (or all of these!), focusing is a gift you can bring to every relationship – including your connection with your own self.

In this live, 8-week course, you will learn and practice focusing with master teacher Dr. Leslie Ellis. Join before Sept. 15 for a significant discount for the Proficiency in Focusing Partnership award program (aka How to Become an Exquisite Listener).

For those not familiar with Focusing, it is an amazing method for discovering what the body knows about your life and world.  It’s a profound yet gentle way of getting a sense of yourself from the inside.

Focusing is not designed to do alone – it is inherently a relational listening process – and in this course you will not only learn focusing, but also how to listen in a focusing-oriented way. That is, you will learn to attune in a way that naturally deepens your listening partner’s relationship with their inner world.

In my first course for the Jung Platform, I offered the basics of focusing as a way of Accessing the Body’s Wisdom, mainly as a form of self-inquiry. This course takes you a step further so you can both listen to your own embodied wisdom and guide a partner in this process.

Focusing founder Eugene Gendlin said that the intangible magic of human connection is what makes focusing so effective at moving us toward new understandings. When we, as a listener, absorb and reflect back what the focuser is saying, our receptive presence adds more to the equation. This is felt by the person focusing, and allows them to say something further, to take a step they may not have arrived at on their own. There is a beautiful rhythm that is created, a conversation that is greater than the sum of its parts.

In this live course, we will meet for eight experiential sessions. In each, I will teach you an aspect of focusing, and will demonstrate it. Then you will have the chance to practice in small groups, one skill at a time.

You will learn how to deepen your listening partner’s experience of their own depths, but in a way that is safe and guided by the focuser. I will offer suggestions to help keep the process moving, but also manageable. For example, in one session, we will work with the inner critic, that derogatory voice that often pipes up when we first turn our attention inside.

We will also have fun with creative aspects of focusing, and there will be lots of time for debriefing your practice and for your questions, reflections and sharing of the magical moments that often arise in focusing.

Prior courses or experience are not required, although I do recommend that you read Gendlin’s little book Focusing as an introduction.

For those who want to, you can use this course as a stepping stone toward a deeper practice of focusing. When you complete the course and practice sessions, you will be eligible to apply to the International Focusing Institute for the Proficiency in Focusing Partnership Award. This award demonstrates your ability to listen in a focusing way, and enables you to connect with other focusing partners from around the world.

The PFP award is optional. And regardless of whether you choose to pursue it, you will leave this course with a deeper connection to your own body’s wisdom, and a reliable way to access it. And you will have the ability to guide others in this process so you can continue focusing as a practice well beyond the duration of the course.

Focusing pairs well with dreamwork, can help you as a therapist, coach or teacher to help your client or students find their own answers. It can be used to deepen creativity and connection.

The course is available at an early bird price of $295 until Sept. 15. Regular price is $345. Classes are 8 Tuesdays starting Oct. 8, 10:30am to 12:45. (90 minutes of class time, plus 45-minute focusing practice sessions).

For full details and to register, click here.

Are Nightmares Bad for Your Heart?

John’s nightmares visit often, and when they wake him up, he can feel his heart racing and his palms sweating. He has been putting off therapy to address the trauma he knows is fueling his nightmares because it’s just so hard face it. What he doesn’t realize is that this avoidance not only disrupts his peace of mind, but also puts him at higher risk for a heart attack or stroke.

It’s well-known that nightmares can disrupt sleep and affect daytime mood, and that they are associated with a wide range of mental health diagnoses, including post-traumatic stress and increased risk of suicide. What is more recently becoming clear is that nightmares are bad for physical health as well — specifically an increased risk of cardiovascular disease. While I have long been advocating for increased awareness and treatment of nightmares, heart health is yet another reason to pay attention to nightmares. This post summarizes some of the key findings on the intricate relationship between cardiovascular health and nightmares from the past five years.

Nightmares and Increased Cardiovascular Risk

Several studies have shown that frequent nightmares are associated with an increased risk of cardiovascular problems. For instance Nadorff and colleagues (2020) found that those who experience persistent nightmares have a higher likelihood of developing cardiovascular disease. This study involved a large cohort of over 3,000 participants and utilized self-reported questionnaires to assess the frequency and intensity of nightmares, as well as the incidence of cardiovascular events. The key finding was that those with frequent nightmares had a significantly higher risk of experiencing cardiovascular events, such as heart attacks and strokes. The study suggests that the stress and anxiety associated with nightmares can lead to increased sympathetic nervous system activity, which, in turn, negatively affects heart health.

Heart Rate Variability (HRV) and Nightmares

HRV, a measure of autonomic nervous system function and cardiac health, has been a focal point in understanding the link between nightmares and cardiovascular health. A study by de Zambotti et al. (2021) included 200 participants and indicated that lower HRV is often observed in individuals with frequent nightmares. Participants underwent polysomnographic sleep studies along with HRV monitoring. The researchers found that decreased HRV, reflecting reduced parasympathetic activity and increased sympathetic dominance, is associated with poor sleep quality and higher nightmare frequency. This imbalance in autonomic function is a potential pathway through which nightmares contribute to cardiac stress and disease.

Nightmares, Sleep Apnea, and Cardiac Stress

Sleep apnea, a condition often co-occurring with nightmares, has also been linked to increased cardiac stress. A study by Basta et al. (2021) involved 150 patients diagnosed with obstructive sleep apnea (OSA) and examined the presence of frequent nightmares. The research utilized polysomnography to monitor sleep and assessed cardiac stress markers such as blood pressure and heart rate. The study showed that patients with both OSA and frequent nightmares exhibited significantly higher levels of cardiac stress markers compared to those without nightmares. The researchers suggest that the intermittent hypoxia and fragmented sleep characteristic of OSA, compounded by the psychological stress of nightmares, can exacerbate cardiovascular strain.

Psychological Stress, Nightmares, and Heart Health

Psychological factors play a crucial role in the relationship between nightmares and heart health. An analysis by Li et al. (2022) reviewed the interplay between psychological stress, nightmare frequency, and cardiovascular outcomes. This review included data from multiple studies, covering a combined participant pool of over 5,000 individuals. The review concluded that the chronic stress response induced by frequent nightmares can lead to hypertension and other cardiovascular issues. The persistent arousal and anxiety from nightmares activate the hypothalamic-pituitary-adrenal (HPA) axis, leading to prolonged cardiovascular strain. These findings were derived from a meta-analysis that consolidated results from various studies, providing a robust understanding of the link between psychological stress from nightmares and cardiovascular health.

Prospective Studies and Longitudinal Data

Longitudinal studies have provided further evidence of the impact of nightmares on long-term cardiac health. A notable study by Ohayon et al. (2021) followed a cohort of 4,500 individuals over ten years. Participants were regularly assessed for nightmare frequency, sleep quality, and cardiovascular health through clinical examinations and self-reported surveys. The study found that those with chronic nightmares had a significantly higher incidence of cardiac events, including heart attacks and strokes, compared to those without frequent nightmares. This study emphasizes the potential long-term cardiovascular risks associated with untreated sleep disturbances like nightmares.

Taken together, these recent studies underscore a significant link between nightmares and cardiac health, strongly supporting the notion that frequent nightmares can be a risk factor for heart disease. This relationship is mediated by mechanisms that include increased sympathetic nervous system activity, reduced HRV, and heightened psychological stress. Beyond the well-understood need to reduce stress to promote heart health, directly addressing nightmares using established dream therapy methods has the potential to mitigate some of these risks.

References

Basta, M., Lin, H. M., Peppard, P. E., & Young, T. (2021). Cardiovascular disease prevalence in patients with obstructive sleep apnea and frequent nightmares. Journal of Clinical Sleep Medicine, 17(1), 17-23. https://doi.org/10.5664/jcsm.8616

de Zambotti, M., Goldstone, A., Colrain, I. M., & Baker, F. C. (2021). Cardiac autonomic regulation during sleep and the relation with nightmares in women with PTSD. Psychosomatic Medicine, 83(3), 299-306. https://doi.org/10.1097/PSY.0000000000000895

Li, S. X., Lam, S. P., Yu, M. W., & Wing, Y. K. (2022). Nightmares and cardiovascular health: A review of recent evidence. Sleep Medicine Reviews, 58, 101453. https://doi.org/10.1016/j.smrv.2021.101453

Nadorff, M. R., Liu, X., & Germain, A. (2020). Nightmares and cardiovascular health: A longitudinal study. Sleep, 43(5), zsz247. https://doi.org/10.1093/sleep/zsz247

Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2021). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: Developing normative sleep values across the human lifespan. Sleep, 44(5), zsab012. https://doi.org/10.1093/sleep/zsab012

The Alarming Nightmare-Suicide Link: Review just published

In my continuing bid to get the word out about the alarming link between frequent nightmares and increased suicide risk, I wrote a review paper that was just published. In it, I cover the growing body of research documenting evidence of this strong connection. I also explore the potential mechanisms at work that make nightmare sufferers more prone to suicide, and discuss treatment and the need for more research.

Recently, I’ve had conversations with several psychotherapists who came across my writings on this topic. I have been consulting with some of them about clients who fit the typical profile of concern: a person suffering from posttraumatic stress who has nightmares almost every night, and has attempted suicide, or is in danger of doing so.

Much of my work involves keeping abreast of nightmare research, developing and honing a treatment protocol based on current evidence and my depth of clinical experience. I also share this information via my writing and courses, including an online course specifically covering nightmares and suicide, and what clinicians need to be aware of.

Here is the abstract and citation for the paper. Please share it with anyone who might benefit from knowing about this.

The Alarming Nightmare-Suicide Link: Evidence, Theories, and Implications for Treatment

A robust link has been established between frequent nightmares and increased risk of suicide, both in adult and adolescent populations. Yet nightmares remain vastly undertreated for a confluence of reasons: patients rarely talk about their nightmares, clinicians rarely ask about them, and too few clinicians are trained to treat disturbing dreams. Current clinical research shows that nightmares are not only associated with posttraumatic stress disorder (PTSD), but also are more prevalent in most psychiatric disorders. There are myriad reasons for clinicians to inquire about and treat nightmares: Patterns of disturbed dreaming, and content of nightmares can provide warning signs of suicide; dream content can aid in diagnosis, treatment, and assessment of response to treatment; and there are established, evidence-based treatments for nightmares that appear to reduce nightmare frequency and distress, as well as other symptoms of post-traumatic stress. Mechanisms of action remain unclear, and the range of treatment options could be expanded, so further research is needed. In the meantime, viable nightmare screening and treatment options currently exist that have the potential to mitigate suicide risk. This review summarizes the extant body of research in this clinical area.

Ellis, L. (2024). The Alarming Nightmare-Suicide Link: Evidence, Theories, and Implications for Treatment. SIS Journal of Projective Psychology & Mental Health31(2).