Research into the therapeutic potential of psychedelic (serotonergic) substances is experiencing a resurgence after lying dormant in North America for more than 50 years. Early research suggests these once-vilified substances show great promise in treating depression, anxiety, alcohol addiction, and potentially many other challenging conditions. This emerging area is ripe for the use of dreamwork techniques to help with the integration of psychedelic visionary experiences that have much in common with dreams.

Psychedelic visions and dreams: Vehicles for attenuating fear memories

From a neurobiological perspective, dreams and psychedelic visions (PVs) share similar forms of perception, mental imagery, fear memory extinction, emotional activation and distorted senses of self and body. This is according to a comprehensive review of the literature on the neurophenomenology of both dreams and psychedelic experiences (Kraehenmann, 2017). A major difference the author noted is that there is greater clarity of consciousness and meta-cognition in PVs, suggesting these experiences are closer to lucid dreaming (the ability to become aware of the dream state while still in it).

One of the areas of overlap that has significant therapeutic potential is the attenuation of fear memories. During dreaming, the brain’s limbic emotion processing network is more active than in wakefulness; in dreams, fear memories are often revisited, but broken into more isolated units, and associated with novel contexts. These are also the steps that lead to fear memory extinction, with a final step being emotional expression of the new experience, which consolidates the updated version. Even better, Kraehenmann states that “Dreaming might also directly rewrite fear memories via memory reconsolidation.” This process involves activation of an emotional memory, followed by a new, less fearful experiencing of it within the ‘reconsolidation window’ which permanently updates old fear memories.

In my decades of work as a trauma therapist, I have found that dreams provide excellent fodder for further therapeutic effects when reactivated while awake. In those who suffer from frequent nightmares, the dreams are remain fear-laden over time because the memory reconsolidation process is often interrupted as the emotion is so strong it wakes the dreamer up mid-process. But in a dream therapy session, the fear memory can be opened up again via dream re-experiencing. Then, in a supportive environment where fear is significantly reduced, the dream story can be metabolized and rewritten, permanently updating the original fear memory. When I have worked with nightmares in this way, the most common reported effect the removal of the emotional charge from the dream/memory. The memory is still accessible, but no longer activates a fear response, and this changes the dream itself.

The same kinds of mechanisms may be at work in psychedelic journeys – the activation and recombination of fear memories in a way that has the potential to remove the element of fear from the experience. As with experiential therapy for dreams, a similar process can be used for PVs to integrate the visions and hallucinations that have arisen, and to help reduce the emotional charge from the experience if there is residual fear present.

Optimism and Caution

Although psychedelic substances are still illegal in most countries (as was the case with cannabis before widespread legalization), there is an underground community already using these substances for therapeutic benefit. Legal permission is being granted for use in research in limited, but rapidly-expanding ways as early results show both promise and acceptable safety.

There is a dark side, however, to this mostly good news story. Recent studies are mainly small and many of them not well-designed. Within the community already using psychedelics, often in group therapy sessions, there are varying degrees of safety and levels of appropriate supervision. From those pioneering psychedelic journeyers, we mainly hear about the successes, and less about the frightening and disorienting experiences that can also result.

What the community of psychedelic pathfinders are discovering is that preparation, setting and post-treatment integration are key elements of success. Best practices, although still a work in progress, are emerging.  A scoping review by Golden and colleagues (2022) found that the main aspects of setting that can positively impact the experience include music/sound, religious or ritual contexts, group versus individual sessions, socio-cultural norms/expectations, and physical environment. Unfortunately, researchers found the existing data is too patchy, sparse or observational to establish evidence-based practices. Adding to the complexity, responses vary across individuals.

Despite the lack of empirical evidence about the factors that lead to success, early research into use of psychedelics for specific clinical conditions is quite promising. A recent meta-analysis of current research shows that psychedelics (psilocybin, LSD, ayahuasca) can be a part of safe, effective treatment protocol for depression, even in treatment-resistant, life-threatening cases (Ko et al., 2023). Another systematic review of 16 studies conducted between 2000 and 2020 showed that psychedelic substances were safe and effective for depression, anxiety, OCD, and tobacco and alcohol use disorders. They noted that the effects appeared to last weeks or even months after just 1-3 sessions, with no severe adverse effects reported (Andersen et al., 2021).

As someone who works with dream material and teaches therapists how to help clients navigate these rich imaginative realms, I believe these same methods can help with the integration of the dream-like aspects of psychedelic journeys. This feels like a rich potential extension of methods developed for experiential dream therapy and in particular, a way to continue the process of taking the charge out of frightening memories and images.

Andersen, K. A., Carhart‐Harris, R., Nutt, D. J., & Erritzoe, D. (2021). Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern‐era clinical studies. Acta Psychiatrica Scandinavica, 143(2), 101-118.

Golden, T. L., Magsamen, S., Sandu, C. C., Lin, S., Roebuck, G. M., Shi, K. M., & Barrett, F. S. (2022). Effects of setting on psychedelic experiences, therapies, and outcomes: A rapid scoping review of the literature. Disruptive Psychopharmacology, 35-70.

Ko, K., Kopra, E. I., Cleare, A. J., & Rucker, J. J. (2023). Psychedelic therapy for depressive symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 322, 194-204.

Kraehenmann, R. (2017). Dreams and psychedelics: neurophenomenological comparison and therapeutic implications. Current neuropharmacology, 15(7), 1032-1042.

The road to recovery from addiction has many challenges, but the intensification of dreams does not have to be one of them. The return of one’s dreams is normal, a good sign, and can be an ally in processing the upwelling of emotion that occurs during the recovery process.

Those who vow abstain from using their addictive substance of choice face many challenges in the early stages – cravings, loss of a familiar way of coping, boredom, periods of emotional intensity and a need to shift away from familiar habits and social patterns that went along with their substance use. What those in recovery don’t expect is to be further challenged (or helped) by their dream life.

Dreams of substance use are common among those in early recovery. They are often vivid enough to feel entirely real. For example, early in his abstinence from alcohol, ‘John’ dreamt of being at a party, carousing with his friends, downing a drink and reaching for another, firmly embedded in his pre-recovery life… only to wake and realize he had been dreaming. According to Kelly & Greene (2019), a ‘using dream’ leads to initial feelings of guilt and remorse, as if one had actually stepped off the wagon. This is typically followed by a sense of relief that the relapse didn’t happen in waking life, and that relief is a good sign.

Counsellor Aubrey Johnson, a student in my Embodied Experiential Dreamwork program, specializes in working with clients in addiction recovery. As her project for the class, she presented on the ‘using dreams’ of those in the recovery process. She said the research validates what she has often witnessed: the intensification of dreaming, especially in the early stages of recovery. In fact, these dreams are so intense they can be characterized as nightmares, and are a known phenomenon in addiction medicine.

One study (Millios, 2016) found that a full 84% of those pursuing sobriety were having substance-related dreams at 7 weeks’ abstinence. After a couple of months, the frequency of using dreams begins to diminish quickly, but they can revisit for a lifetime. Johnson says this make sense because recovery is also a life-long process. And although the study found REM rebound dreams peak at 7 weeks, she has seen the intense dreaming last for several months in some cases, and for the dreams to bring up challenging emotions associated with addiction.

What Induces Dreams of Using?

On a physiological level, REM Rebound accounts for much of the increased dream frequency and intensity. Many addictive substances, including alcohol, cannabis and benzodiazepenes suppress REM sleep and dreams. These substances can also disrupt natural sleep cycles, creating a deficit in REM/dreaming. When a person stops using a REM suppressant, their body immediately begins to make up for the REM deficit. Until natural sleep rhythms are restored, the person in early recovery will experience longer and more intense dream-rich sleep.

This explains why there are so many dreams, but why dreams of using? If Freud was right that some dreams express fulfillment of wishes, these dreams can be an unconscious reflection of the desire to use, and return to memories of euphoric experiences while under the influence. We tend to dream about powerful emotions, and especially those we repress, so it’s not surprising that memories of substance use will be woven into the dreams of those in recovery. It’s similar to the common experience of dreaming of one’s ex-partner in the weeks and months following a difficult break-up.

Addiction is now being understood not as a disease but as a way to self-regulate, often a response to trauma and overwhelming emotions (eg. Winhall & Porges, 2022). Addictive behaviors can stall emotional growth as challenging feelings are not being processed, but rather bypassed or numbed. The recovery process involves acknowledging hard feelings that have long been avoided, and learning alternative ways to be with and metabolize them. One of the functions of dreaming is emotional regulation; more turbulent feelings tend to express themselves in more intense dreaming. Rather than see this a problem, I suggest making the dreams allies in the recovery process, an aid to emotion processing. Encourage your clients to befriend the dreams, listen to them, welcome them, and in turn they will become friendlier, clearer and more helpful.

Are Using Dreams Helpful or Dangerous?

There is some conflicting evidence about whether dreams of using promote or prevent relapse, a great fear amongst those on that path to recovery. In keeping with the many theories of dreaming as a simulation, Kelly & Greene suggest using dreams may be a way of rehearsing situations that might tempt one to relapse, increasing awareness and motivation to stay sober. However, dreams of using can also increase cravings because they return the dreamer to a lived experience they may be missing.

Johnson, who works with the ‘using’ dreams of those in her practice, suggests some helpful practices for others who work with the dreams of those in recovery from addiction. She said it’s helpful to tell clients that using dreams are normal and highly prevalent, and they do not indicate potential relapse or that anything is going wrong. In fact, discussing the dreams can help the client struggling to adapt to abstinence by providing images that aid in processing the spectrum of emotions associated with the recovery process.

Kelly, J. F., & Claire Greene, M. (2019). The reality of drinking and drug using dreams: A study of the prevalence, predictors, and decay with time in recovery in a national sample of U.S. adults. Journal of substance abuse treatment, 96, 12–17. https://doi.org/10.1016/j.jsat.2018.10.005

Millios, R. (2016). Dreams in Recovery: “Using” and Relapse Dreams – What Do They Mean? American Addiction Centers. https://recovery.org/pro/articles/dreams-in-recovery-using-and-relapse-dreams-what-do-they-mean/

Winhall, J., & Porges, S. W. (2022). Revolutionizing Addiction Treatment with The Felt Sense Polyvagal Model. International Body Psychotherapy Journal, 21(1).

Feel into the dream images to arrive at your own answers

Yes, you read that correctly. So many people come to me with a dream image or story and want an immediate answer to the question: what does it mean? It’s natural to want to know this because dream images are often so strange and powerfully evocative that we sense there is meaning in them.

But I want to impress on you that meaning in dreaming is not the same as an intellectual understanding or a goal-oriented response to the image. Dreams almost never present a life situation and spell out what you should do. They are asking you to do something quite different – to feel into the image and arrive at your own answers.

When friends ask me what their dream means, I think they are often looking for a particular solution, a quick explanation that will make the dream make sense. But this isn’t how dreams convey meaning. When we’re dreaming, our prefrontal cortex, the part of our brain that thinks logically and makes plans for the future, is mostly asleep. That’s why we can’t seem to find our gate at the airport, act in a decisive fashion, or even notice that we are in the strange world of dreaming. Dreams don’t come from a place of logic but instead are mediated by a different set of neural correlates, the same as those active in daydreaming. It is an imaginative and creative state that moves forward in non-logical steps.

Dreams are the same – they are a world apart from logic, characterized by images and infused with emotion. So to really understand a dream, you need to feel your way into the image. The meaning will come through your body and not necessarily in words, but rather in a felt sense of meaning and of depth. Dream meaning takes you deeper than words, so to really grasp it I suggest you first revisit it experientially, immerse in the felt meaning and then you can try to express this in words, images, music, movement, or whatever medium seems best.

This creative expression will point to the meaning of your dream, though may never quite capture it all. This is because we never have perfect recall of our dream-state experience. There is always a sense of having left far more insight and experience in the dream realm than we can recall. We are left with snippets and fragments and can piece a sense of the whole together from there. It will be imperfect, much like a piece of writing or drawing will never be exactly like what you are trying to express. But the attempt to express is what will bring you closer to how your dream expresses the felt meaning it carries.

Meaning and memory sources are not the same

Sometimes dreamers think they understand the meaning of their dream because they can identify the memory sources of their dream. If they saw a scary movie the night before dreaming about a ghost, they’ll say the movie is why they dreamt about a ghost.

This is only partly true. Dreams do pick up ‘day residue’ and also older memories as source material. I see these as a palette for our dream-maker to draw from and recombine so that the dream weaves images that are uniquely meaningful to us. I believe particular images are presented in a way that evokes a nuanced kind of felt sense that we will recognize. Dreams draw from images from our past and yet mostly create new images that are hybrids of things we know and things that are new. Just because you can recognize the memory source doesn’t mean that you already know what the dream means. You’ll still have to feel your way into the image, to understand it at an embodied level.

Dreams express themselves through an embodied emotional experience and can only truly be understood if you re-enter that experience and allow it to speak to you. If you’re looking for a tidy, simple explanation of your dream, you are not going to find it. Or if you do come up with an explanation like that, it may satisfy your intellect, but it won’t be complete. Instead, it will be a delimiting version of what your dream might mean. Like a felt sense, the dream always means more and can open us up to much more than we can immediately say about it. This is part of what makes them so deeply evocative.

What’s the single most important factor in a successful dream group?

Safety.

This may be why the method of Dream Appreciation by Montague Ullman is the most popular dream group method. Every step of the way, the dreamer’s safety is considered.

What maintains the dreamer’s sense of trust in the process? Confidentiality of course, and the ability of the dreamer to stop the process at any time. Beyond the obvious, the main consideration is the deepest respect for the dreamer and their dream.

This means no leading questions or imposition of ideas from the group, however brilliant they may seem. Ullman said, “The goal is to lead the dreamer into a dialogue with their own dream.” Anything else “shifts the dreamer’s attention from the dream to the motives of the questioner.”

He uses the analogy of curling to help us understand this concept. In curling, the skip (aka dreamer) sends the rock towards its target. The sweepers clear the path for the rock, help it on its intended journey, but do not change its course. “We respect the importance of the dreamer, staying with the path of the dream rather than deflecting them into a path of our own making.”

Ullman advises against offering interpretations, ideas about symbolic meaning, or anything from outside what the dream itself contains. “I don’t think it is ever truly therapeutic to approach a dreamer with an a priori conviction about what a dream means based on a particular theory or preconceived ideas about what certain images mean.”

What kinds of inquiries should dream group members offer then? Ideally open-ended questions with no agenda other than helping the dreamer to further open the dream itself. Our questions “should always lead back to the dream.”

Questions with an agenda promote defensiveness. But if there is trust and safety, “the clarity of one’s emotional vision becomes sharper and deeper. Trust opens the dreamer up to the possiblity of discovery.”

From: Ullman, M. (1996). Appreciating Dreams, a group approach. Sage Publications.