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How Are You Dreaming? A Very Simple Question to Screen for Suicide Risk

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Your dreams are an excellent barometer of your emotional life. And for those at risk for suicide, they can be a warning sign that is too often ignored. I have been calling for more clinicians to ask about dreams when their clients are dangerously depressed, and am pleased to see that others are joining the chorus.

Geoffroy (2023) wrote a letter to the journal, Bipolar Disorders suggesting that clinicians ask one simple question of their clients at risk for suicide: How are you dreaming? He states that dreams and their recent changes represent “a meaningful warning signal of the suicidal crisis.” This simple inquiry could help detect one of the foremost causes of death worldwide, particularly lethal in youth populations.

There is a clear and growing body of evidence to show that nightmares represent an independent risk factor for suicide, even when depression, post-traumatic stress and other risk factors are adjusted for. I have written a comprehensive review article of this evidence, now in press (Journal of Projective Psychology and Mental Health, 2024). Here is the abstract:

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.

Some compelling evidence cited by Geoffroy in his letter includes a review by Akkaoui and colleagues (2020) which concluded that chronic nightmares affect up to 70% of patients with personality, mood or post-traumatic stress disorders. The researchers concluded: “Nightmares are overrepresented in mood and psychotic disorders… These findings emphasize major clinical and therapeutic implications.”

 

Changes in Nightmare Content Can Predict Suicide
Another recent study underscores the importance of tracking the dream content of those in crisis. Geoffroy (2022) offers some clarity about specific ways that nightmares escalate prior to a suicide attempt. The study of 40 patients hospitalized for suicidal crisis found that 80% had experienced changes in their dream lives prior to their crisis. Two-thirds experienced bad dreams, half had nightmares and 22% had dreams about suicide. The researchers also noted a progression in the way dreams changed, with bad dreams appearing 4 months’ prior, nightmares 3 months’ prior and suicidal scenarios 1.5 months’ prior to the suicidal crisis. They concluded: “Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.”

Nightmares and suicide are clearly linked, and much more can be done to research, inquire into and treat nightmares as a way of reducing suicide risk. In my clinical experience treating trauma and nightmares over two decades, I see great benefit in treating these dreams. The content itself can point to areas of trauma that need to be metabolized and integrated, and when this is achieved, the nightmares tend to change or sometimes cease altogether. Also, when patients are taught simple ways to rescript their nightmares, this can provide a constructive alternative to rumination leading to suicidal thoughts. These dreamers say they feel empowered when they know they can do something about their nightmares, which increases hope and agency, and improves sleep quality. All of these factors can reduce suicide risk.

Don’t miss our 1-hour seminar on critical information for therapists about nightmares and suicide, including current research and how to help. We are currently offering a 30% discount! Click here to avail the promo!

For those interested in learning more about nightmare treatment and the nightmare-suicide link, I have a range of online courses available covering these topics in detail at https://drleslieellis.com/products/

References

Akkaoui, M., Lejoyeux, M., d’Ortho, M. & Geoffroy, P. (2020). Nightmares in Patients with Major Depressive Disorder, Bipolar Disorder and Psychotic Disorders: A Systematic Review. Journal of Clinical Medicine, 9(12), 3990.

Ellis, L. A. (2024, in press). The Alarming Nightmare-Suicide Link: Evidence, Theories and Implications for Treatment. Journal of Projective Psychology and Mental Health, 31(2).

Geoffroy, P. A. (2023). How Are You Dreaming? A Very Simple Question to Screen for Suicide Risk. Bipolar Disorders, (25)4, 341.

Geoffroy, P., Borand, R., Ambar Akkaoui, M., Yung, S., Atoui, Y., Fontenoy, E., Maruani, J., & Lejoyeux, M. (2022). Bad dreams and nightmares preceding suicidal behaviors. The Journal of Clinical Psychiatry, 84(1), 22m14448.

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How to be a Soothing Presence: Keeping Nothing Between

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The essence of working with another person is to be present as a living being. And that is lucky, because if we had to be smart, or good, or mature, or wise, then we would probably be in trouble. But, what matters is not that. What matters is to be a human being with another human being. – Eugene Gendlin, The Primacy of Human Presence

 

How best to accompany those suffering from grief, extreme stress or trauma? It’s a question that has been coming up a lot in my life and work. It seems as though many of us are searching for just the right technique, or thing to say in the face of deep suffering, and feeling unequal to the task. I believe it’s part of being human to experience a mix of joy and suffering, and that we are all capable of helping those in pain.

In a recent group I host for the Polyvagal Institute, we had a conversation about how to help those experiencing the effects of trauma and dysregulation. While there are lots of excellent and well-known techniques, like slowing the breath or orienting to inner and outer resources, our conversation led to something more important, beyond technique. Underlying all the suggestions you may have to soothe a person who is suffering, the most valuable thing you can offer is simply your presence.

 

We are designed to co-regulate

There are some practical ways to cultivate a sense that we are safe to others. If we can embody and convey a sense of calm and reassurance, this is contagious. As mammals, we are designed to pick up cues of safety, so when those around us feel comfortable enough, we can settle in a sense of safety too.

However, the ability to co-regulate is not something that can be falsely manufactured. What if I don’t feel all that safe and settled, and I still want to be a source of help and comfort? This is where a powerful idea from psychologist/philosopher Eugene Gendlin can help. In his lovely piece on ‘Keeping Nothing Between’, he suggests we don’t need to be anything other than who we are in the moment, our fallible human self. Our very willingness to be open and vulnerable is an invitation to trust.

I am sharing an excerpt here, from Gendlin (You and I – The Person in There), hoping you find it as inspiring as I do:

“In a restaurant a little girl in the next booth turns to look at you. It is an open look, direct from her – to you. She doesn’t know that strangers are not supposed to connect. She does not put this knowledge between herself and you. There is nothing in between. You look back. Her parents make her sit down and face forward. But then, when they all leave, she turns around at the door, to look again. After all, you and she have met therefore she wouldn’t just leave.

In first grade the children look at the teacher searchingly, openly, reachingly. They put nothing between. The teacher is concerned with the eight levels of reading ability, and does not look back.

Do only little children keep nothing between? Or can adults do that too? We can, but for us it is a special case.

If you came to see me now, I would not look at you like that, nor would I notice if you looked. You would find me in a certain mood in my private struggles. I am also preoccupied with writing this paper. If you suddenly walked in, a third cluster would come: The social set for greeting someone properly. I would respond to you out of that set. Or if you are an old friend, I would respond from the familiar set of the two of us. If you then wanted to relate in some fresh, deep way, it would take me a minute to put our usual set aside, to put my concern about my chapter away, and to roll my mood over so that I am no longer inside it. Then I would be here without putting anything between. But it would be easier to remain behind all that, and depend on my automatic ways.

If I really want to be with you, I keep nothing in front of me. Of course I know I can fall back on the automatic ways. If need be, I can also defend myself. I have many resources. But I don’t want all that between us.

If I keep nothing between, you can look into my eyes and find me. You might not look, of course. But if you do, I won’t hide. Then you may see a very insufficient person. But for contact, no special kind of human being is required. This fact makes a thick peacefulness.”

Wishing you and yours a ‘thick peacefulness.’

 

For those interested in learning more about Gendlin’s gentle somatic art of Focusing, I have a short introductory course on my web site under Products. I am also offering a live 4-class course via the Jung Platform starting Jan. 23, 2024 — which will be available as a recording after this. Here is the link: https://jungplatform.com/store/focusing-accessing-the-bodys-wisdom/partner/frxszk/

 

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The Vagal Paradox: A Current Summary of Polyvagal Theory

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Porges’ recent article has two main purposes: first, to set out a clear, complete description of the Polyvagal Theory in accessible language to clear up confusion and misconceptions among those who apply and describe it; second, to systematically address criticism of PVT in the literature. This is a summary of the former, especially as it relates to the mental health professions.

Porges never dreamed that when he introduced the Polyvagal Theory (PVT) in 1994, it would attract both intense interest among trauma therapists, and also persistent criticism from some scientists. He wrote The vagal paradox: A polyvagal solution (2023) to correct some of the many misconceptions and misrepresentations about PVT in the literature. He takes pains to express the PVT as clearly as possible, aware that those without education in the foundational sciences required to understand the complexities of this cross-disciplinary theory will continue to apply it and describe it to their colleagues. He notes that “misunderstandings can become misinformation in the digital world.”

The ‘vagal paradox’ paper carefully describes the foundations of the theory, what it covers and does not. It is the clearest, most complete description of PVT to date. The following is a summary of the main ideas Porges presents about PVT, in particular what is new in how he describes the theory and what is of highest relevance to mental health professionals. It does not cover the sections where Porges tackles specific detractors of PVT, most often pointing out why their argument is irrelevant to PVT or shows a lack of understanding of its scope and foundations.

Porges devotes about half of the article to addressing his critics — the main point is that PVT is a respected and testable theory. It has been cited in more than 15,000 peer-reviewed journals. PVT has also been enthusiastically adopted as a non-pathologizing way for therapists to help those with a history of trauma to make sense of their body’s responses to threat, and to recover. As trauma therapists, we can use PVT with confidence that it rests on a solid academic foundation.

 

The vagal paradox

Much of the description of PVT is unchanged and will be familiar to those who have studied it. The theory came about as a solution to the ‘vagal paradox’ that the vagus nerve in mammals could be both health-promoting and lethal. Porges observed this paradox in his research with preterm infants, for whom the vagus, usually associated with helpful calming, could also stop the heart.

The vagus, a cranial nerve that travels from the brain stem to many organs, is the primary neural pathway of the parasympathetic nervous system. It is primarily sensory, with 80% of its fibres carrying information up from the organs to the brain. The other 20% are inhibitory motor fibres that can act as a brake on the heart and stimulate the gut.

How can the same nerve help or kill? Because it splits into two branches, emerging from the dorsal and ventral areas of the brain stem, and each function very differently. The PVT describes the anatomy, development, evolutionary history, and function of the two (poly) vagal systems.

The PVT had a focus on how the vagus nerve evolved differently in mammals (although modern reptiles and mammals share a common, ancient reptilian ancestry). Porges describes how in mammals, some of the cardioinhibitory neurons migrated from the dorsal to the ventral branch of the vagus to form part of the ‘ventral vagal complex.’ This allowed for down-regulation of threat responses necessary for nursing, co-regulation and attachment, which are distinctly social, mammalian features.

Porges describes how respiratory sinus arrhythmia (RSA) can be used to track the impact of the two vagal pathways through early development. The myelinated cardioinhibitory fibers from the ventral vagal nucleus have a detectable respiratory rhythm. Research has shown RSA has lower amplitude in preterm infants, whose ventral pathways are not yet fully developed, and that this both improves as the infant matures and can be increased further through social engagement. By contrast, when bradycardia (slowed heart rate) is observed in preterm infants, this appears to be mediated mainly by dorsal vagal pathways (though further research is needed to determine if ventral pathways are also recruited).

 

Dissolution: Evolution in Reverse

An important key to understanding PVT is the Jacksonian principle of dissolution, the observation that evolutionally-newer circuits inhibit older ones except under stress or injury, when changes happen in reverse of this sequence. PVT extends this principle, originally applied to the brain, to include the autonomic nervous system (ANS). Our nervous system develops in this hierarchical fashion: older autonomic circuits (dorsal vagal and sympathetic nervous system) develop first, followed by the newer (ventral vagal, parasympathetic) circuits. It makes sense to Porges that older circuits “would sequentially be disinhibited to optimize survival… under challenge there is a progression that could be characterized as either evolution or development in reverse.”

Porges felt it important to note that the dorsal vagus has beneficial functions, especially related to digestive processes. “PVT proposes that when the ventral vagus is optimally managing a resilient autonomic nervous system both the sympathetic and dorsal vagus are synergistically coordinated to support homeostatic functions including health, growth and restoration. However, when ventral vagal influences are diminished… the sympathetic and dorsal pathways are poised to be sequentially recruited for defense.”  These steps are more commonly known as fight/flight and then collapse/immobility responses in the popular descriptions of PVT. In the body, these steps are observed as increased heart rate and suppression of the dorsal vagal calming of gut and heart. This sympathetic state is metabolically demanding. To reduce demands, the dorsal vagal influence may surge, lowering blood pressure, reducing heart contractility and clearing the bowel (dorsal vagal collapse).

 

Ventral Efficiency: A Dynamic Measure

The ventral vagus acts as a brake on the heart, which has an intrinsic rate of 90 beats per minute. “PVT specifically assumes that the vagal brake is mediated primarily through the myelinated ventral vagus and can be quantified by the amplitude of RSA.” Porges introduces a new measure, that of ventral vagal efficiency (VE), to account for the fact that the vagal brake functions in a dynamic manner in response to the environment. This involves evaluation of short sequential shifts or ‘epochs’ to capture the dynamic relationship between RSA and heart rate. Porges lists several studies using VE as a measure, including his own preliminary research showing lower VE for those with a history of maltreatment, which in turn mediated increased symptoms of anxiety and depression.

Porges suggests that VE reflects a disruption in feedback between the heart and brainstem that could lead to body numbness and index autonomic regulation to stressors and psychiatric symptoms. “Blunted VE may be a mechanism through which maltreatment induces mental health risk and interventions aimed at promoting efficient vagal regulation may be promising for improving resilience and wellbeing in trauma survivors.” He suggests VE could be a “powerful, low cost, easily quantifiable and scalable measure” for screening for low ventral vagal efficiency.

 

PVT: Five Key Principles

In order to understand PVT, Porges suggests there are five key principles. Most of them have already been described in this summary, but they will be explicitly listed below. PVT has evolved since its introduction 30 years ago, in part due to the intense interest and interaction with trauma therapists and survivors who found PVT to be a helpful and liberating explanation for their own embodied experiences. For example, many understood for the first time why they were unable to fight or flee when under attack.

In the process of developing PVT and interacting with the research and clinical communities that have embraced it – the notion of the vagal complex as a process not measurable through standard cause-and-effect principles has emerged. Porges describes PVT as a neural algorithm in which testing by traditional randomized controlled trials does not apply.

Instead, Porges envisions an index of autonomic signatures describing autonomic responses to specific situations. “Perhaps the most informative aspect of such an algorithm would be to identify the autonomic pathways that would support the ability to down regulate threat to enable mobilization and immobilization to occur with trusted others and not trigger defense… It is this process of functionally liberating mobilization and immobilization from defensive threat driven strategies that PVT hypothesizes to have supported the emergence of social behavior and cooperation in species of social mammals.”

This leads naturally to the first principle:

  1. Autonomic state functions as an intervening variable

This principle stresses the capacity of the ANS to dynamically respond, adapt, process and recover from challenges. “PVT emphasizes an important perspective missed by correlational research – how the ANS is part of an integrated response, not a covariate.” This notion transforms how research would be conducted since it emphasizes integration of autonomic, cortical and somatic systems, shifting research targets from correlation to all of the parameters that mediate such integration. Porges said this could curb the tendency to generate faulty causal inferences from high correlations that can lead to inappropriate treatments and poor outcomes.

  1. Three neural circuits form a phylogenetically ordered response hierarchy that regulate autonomic state adaptation to safe, dangerous and life-threatening environments.

This is the cornerstone of the PVT, and well documented in this and other polyvagal literature, however Porges continues to refine his description. The PVT emphasizes there are three neural circuits that regulate and shift autonomic state in response to signals of safety, danger and life threat. PVT describes the mammalian response hierarchy in terms of biobehavioural scripts initiated.

“The phylogenetic sequence is initiated by a dorsal vagus, followed by a spinal sympathetic system, and finally with the ventral vagus. By identifying the biobehavioural scripts of each of these circuits, we become appreciative of the efficiency of the three neural circuits in an attempt to optimize survival,” Porges wrote.  These scripts help us to identify when the system in a safe or threatened state, and if the latter is fight/flight or immobilization. PVT shows how in a safe (ventrally-mediated) state, the system supports health, growth, restoration and sociality.

  1. In response to challenge, the ANS shifts to states regulated by circuits that evolved earlier consistent with the Jacksonian principle of dissolution, a guiding principle in neurology.

This has been described above.

  1. Ventral migration of cardioinhibitory neurons leads to an integrated brainstem circuit (ventral vagal complex) that enable the coordination of suck-swallow-breathe-vocalize, a circuit that forms the neurophysiological substrate for an integrated social engagement system.

The ventral migration of cardioinhibitory neurons became integrated in the regulation of the striated facial muscles used in ingestion and expression. This led to the formation of a social engagement system in mammals that enables a shift from states of defense to those of connection through co-regulation. The PVT describes how the presence of trusted others, especially if they project calm and safety through voice and gesture, can help a person shift into a calmer state. Such features can also be incorporated into trauma therapy.

  1. Neuroception: reflexive detection of risk triggers adaptive autonomic state to optimize survival.

Porges coined the term ‘neuroception’ to emphasize that the scripts initiated by the ANS in response to perceived safety and threat operate outside of awareness and are not under cognitive control. Because these are survival responses, the time it takes to assess and think about a response might be too long, hence these processes are reflexive, “unimpeded by intentionality and cognitive appraisal.”

 

In conclusion…

This article has not only offered a complete, and accessible summary of the development and current state of the PVT, but has also shown that it rests on a firm academic foundation. In addition, it paves the way for future research, and prescribes a significant shift in how such research ought to be conducted to faithfully capture the dynamic and integrative nature of the ANS. Most importantly for clinicians, PVT offers a humane and hopeful path for those who have suffered severe trauma – both a way of understanding symptoms, and a supportive path toward healing.

 

Reference:

Porges, S. W. (2023). The vagal paradox: a polyvagal solution. Comprehensive Psychoneuroendocrinology, 100200.

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Dreams of the Dead: Normal or macabre?

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In my daydreams, my grandmother and I sit on beach chairs and look out at the ocean. We’re on a deserted beach like something from Pirates of the Caribbean. She’s always there, contentedly sitting in a low-slung Adirondack chair amongst the grass tufts and dunes. When I drop in, she often tells me to slow down…

The secret is out: most of us maintain a conversation with deceased loved ones, in the form of dreams, sense of presence and/or some form of direct communication (telepathy, imagination, visitation…?) This recent finding by the Pew Research Centre is corroborated by the work of grief dream researcher Joshua Black, who says that dreams of the deceased tend to ease the process of grieving, offering messages of comfort and assurance.

Black became interested in grief dreams when he had a visitation in a dream about his father three months after his death. His dad had died suddenly, plunging Black into grief he described as numbness, “as if all the color had drained from the world.” In the dream, Black said his dad had an uncharacteristic lightness about him. “It was the first time I saw him peaceful.”

In the dream, Black got to tell his dad he missed and loved him. After that, the color returned to his world, and Black decided to devote his life’s work to researching dreams of the deceased. The desire to maintain continuing bonds with the dead is a key factor in such encounters and this is what Black continues to study.

For example, in 2020, he investigated the question: “Why are some dreams of the deceased experienced as comforting, while others are distressing?” In his study with 216 participants whose partner had died, he and his colleagues found that bereavement dreams appear to serve at least three distinct functions: they can assist with processing trauma; they can serve to maintain a bond with the deceased; and/or they can help regulate emotion. Taken together, these functions may “actively facilitate adjustment to bereavement.”

The recent Pew Research Centre study found that more than half of U.S. adults were visited in their dreams, or in some other way, by a dead family member. A third said they ‘felt the presence’ of a deceased relative, 28% said they told the dead relative something about their life, and 15% experienced the deceased communicating to them.

It turns out to be quite normal to have an ongoing relationship with loved ones who have passed away. Dreams, inner conversations and visitations are the typical forms this can take. A full 53 percent of the 5,079 surveyed said they experienced at least one of these interactions in the past year. This experience is more common to women than men, and greater amongst those who are moderately (but not highly) religious.

A question that arises is whether the dead have indeed spoken, through dreams or telepathy, or whether we are creating a personal representation of the loved ones we have lost when we dream about or speak to them. This depends greatly on what you believe about the nature of death and the possible continuity of consciousness beyond it. I like to think the dead really visit, similar to what those in Latin countries believe happens during the Day of the Dead rituals and celebrations.

Many cultures believe the deceased maintain communication with loved ones – and it is this belief that is at the centre of the Day of the Dead celebrations. During this period, which actually lasts several days, it’s believed that the border between living and spirit worlds dissolves, and souls of the dead return to feast and play with their loved ones.

Regardless of belief around the true nature of communication from those who have passed away, we know that maintaining a connection with the dead is common, and that it helps with the passage of grief and beyond. I still talk to my grandmother in my imaginal journeys, I feel her presence when I’m gardening and sometimes, just when I need it. I am heartened to discover that I am not alone in these comforting encounters.

 

Black, J., Belicki, K., Emberley-Ralph, J., & McCann, A. (2022). Internalized versus externalized continuing bonds: Relations to grief, trauma, attachment, openness to experience, and posttraumatic growth. Death studies, 46(2), 399-414.

Tevinton, P. & Corichi, M., 2023. Many Americans report interacting with dead relatives in dreams or other ways, Pew Research Center. United States of America. Retrieved from https://policycommons.net/artifacts/4775476/many-americans-report-interacting-with-dead-relatives-in-dreams-or-other-ways/5611706/ on 30 Aug 2023. CID: 20.500.12592/wcfmq3.

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How to Have Beautiful Daydreams: Reassign the Inner Critic

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The minute you turn your attention inside, are you greeted with a cruel, relentless voice that hits you in the most tender, wounded places? For some people, the invitation for the mind to wander leads directly to the inner critic. Below are some ideas to help make your inner world a more supportive place.

In our lives (and in our clinical practices), we have all encountered the inner critic, an inner watchdog alert to our every real or imagined misstep. This can be a true impediment to connecting deeply with ourselves from the inside. Although everyone has a different version, the basic experience is the same: that of a repetitive and demeaning refrain that knows our particularly sensitive spots and sends critical messages right on target. Often just as we (or our clients) start to feel good and strong, an inner voice enters that deflates us, telling us we are not smart/successful/good/pretty/talented… in some way, just not enough.

In my 20 years of clinical practice, I have encountered many versions of the inner critic and find that the more trauma someone has suffered, the more intense this inner voice becomes. I think it’s in part because as children, we rely so much on our caregivers that if something is wrong with the relationship, it is too scary to blame those we rely on for our very survival. So the badness must be inside of us. It is a protective idea that helps at the time but outlives its usefulness. However, because it was acquired at a young age, the critic’s message often feels ‘true’ and is accepted without question. You might want to consider its origin and question its message. It can be a revelation to simply say, you don’t have to believe your inner critic.

The inner critic is an ancient survival mechanism

Neuroscience expert Dan Siegel says the inner critic originates in our internal ‘checker,’ the vigilant part of ourselves that enabled our ancestors to survive. Those who were most alert to danger, and to something being wrong were more likely to survive and to pass on their genetic heritage. However, the ‘checker’ can manifest in many unhelpful ways such as obsessive compulsion, anxiety and also as the inner critic.

This idea that our inner critic is an outdated survival mechanism inherited from our ancestors may give us a bit of objective distance from it. The inner critic is not something to believe without question, especially as most of us now live in a world where physical survival is rarely at stake.

Siegel’s suggestions for working with the inner critic are: to get curious about the nature of that voice, notice what brings it up and what it wants for you. Or more often, what it doesn’t want for you, as the inner critic often stops us from doing things. Thank it for its protectiveness, notice the ways it has become too cruel or vigilant,  and mutually try to figure out a better way to forward.

Thoughts are not facts

Just because something enters our mind doesn’t mean we have to believe it’s true. This may seem obvious, but very often people in the grip of an internal attack do not stop to question the veracity of their thoughts. In depressed clients, I have often seen them make up a whole story that makes themselves wrong or bad, maybe involving other people they imagine are thinking disparaging things about them – and then react as though this entire fantasy is real.  I like to label these thought trails as fantasy. Then I invite them to inquire into the origin of this felt sense, and to tend to it from there. When the source of the self-criticism is tended to, the critic tends to shift and soften too.

The critic often has its roots in childhood, and from that vantage point, the message might make more sense, because it actually was, or felt like it was, true at the time. Or it somehow offered necessary protection, for example keeping us subdued and quiet so as to be less of a target. I suggest my clients give the critic a new job: Update the critic on the current situation, enlist their constructive help. The critic can become an ally.

Reassign the ‘Loyal Soldier’

Hiroo Onoda was a Japanese soldier who refused to surrender after World War Two ended. He spent 29 years in the jungle on an island in the Philippines, engaged in his military duties (and killing 30 people!). He remained there until 1974, because he truly did not believe that the war had ended.

During his time on the island, he ignored search parties and leaflets sent from Japan to get him to surrender, dismissing them as ploys. He was finally persuaded to emerge after his ageing former commanding officer was flown in to personally relieve him of his duties. Still dressed in a tattered uniform, he handed over his Samurai sword and went home to Japan where he was greeted. He became a rancher and survival training teacher. He died in 2014 at age 91.

This story suggests many things I think are true of the inner critic: that the critic has good intentions and is protective in some way, that it is operating on an outdated set of orders that it will not easily give up, and that in order to shift its energy to something more constructive, it needs to be acknowledged, thanked, relieved of its duties and reassigned. It needs to know the war is over and it can put its sword down.

Because the inner critical voice is thought-based, sometimes cognitive techniques can be helpful. Therapist and author Rick Hanson suggests thought-labelling: “Oh – anxiety. Oh – self-criticism. Oh – alarmist thinking.” This has been shown in research to do two good things in the brain:  it increases activity in prefrontal regions that are involved with executive control, and it lowers the activity in the amygdala, reducing the sense of alarm.

Hanson refers to an idea that originated with Jung: the concept of the self as a committee of various parts. “If the brain is a committee, the chair of the committee, roughly, tends to live right behind the forehead. So when you increase activation of the chair of the committee, who in effect is then able to say to the self-critical member of the committee, “Oh, we hear you already. We got it. Enough already. Hand the microphone to somebody else.”

Recruit your inner cheerleader

To combat our natural tendency toward the negative, I suggest finding the cheerleader or support person to sit on your inner committee.  If you don’t have one, recruit one. Just as the inner critic is often a composite of the authoritative and judgmental aspects of important people in your life, you can find or create a composite of those who supported you most. Or simply evoke a person or character that can be that for you. Then, when you notice the inner critic speaking, you can turn to the inner support person and ask for their opinion. It’s also like asking: what would the person who supports and loves you most say to that nasty statement from the critic? Let this sink in and be a counterweight to the critic. Over time, you will find that the inner world will become a more benign and supportive place.

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Go Play Inside: Cultivating a Compelling Inner Life, Three Ways

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Chasing external sources of happiness may have failed you, as ultimately our deepest satisfaction comes from within. But often when people turn their attention inward, they don’t like what they find. Dr. Leslie Ellis offers three ways to constructively engage with your inner life.

We all know the road to greater life satisfaction has more to do with how we feel on the inside than with any external riches we may gather, whether they be material possessions, good looks or accomplishments. We all know we should meditate, connect with our deeper self and learn to be content with life as it is right now, rather than waiting for some imagined future where everything will be wonderful again. However, many who turn their attention inward don’t like what they find: stress, inner criticism or maybe just a blank space that isn’t all that engaging.

In my 20 years as a psychotherapist, I have developed a number of simple and constructive ways to check inside that my clients tell me have changed their lives for the better. My goal is always to make my suggestions simple, doable and effective regardless of what might be going on in outside life, where so much of what happens is clearly beyond our control. At least with our inner world, we have some ability to temper and modulate our responses.

Managing stress: your inner tachometer

Getting stress levels under control is the first priority for so many of us. My sense, in working with so many clients with anxiety or depression, is that stress levels are chronically high, and we are not always aware of it. If you are in this boat, I suggest imagining an inner tachometer — and for those who don’t drive a car with a standard transmission, this means the device the measures the RPM of the engine. It idles in the green zone, works hard in the orange zone and can do damage in the red zone.

Try it now: where is your inner tachometer? Those who suffer from chronic stress spend too much time in the red zone. If you tend to take on too much and are always too busy, try to assess decisions about whether or not to add something more to your plate by the state of your inner tachometer. If it’s pushing toward red, do something to bring it down. Say no to the extra commitment, or to packing your appointments so close together you are always rushing. An engine that stays in the green zone lasts longer and our bodies are like that engine. We can’t always control the RPM, but this simple exercise in awareness can shift the tendency to rev on the red line too often.

Befriending yourself: taming the inner critic

The next thing many people find when they look inside, once they have taken the RPMs down a notch, is a nasty, critical voice that seems to find just the right thing to say to undermine confidence and stall forward momentum. Everyone has a version of this, an inner authority figure that combines parental, teacher and employer’s voices to tell us all the ways we are not measuring up. DON’T take it seriously! For many, it is a revelation when I tell them this voice doesn’t speak the truth. It is an artefact of childhood, and the more challenging our early years were, the harsher this voice will be.

A good test: how would you feel if a friend spoke to you in this tone of voice? You would rightfully be insulted and push back. Do the same with your inner critic. Since our brains are wired to focus more on the negative, you need to counter this tendency with something positive. Recruit an inner cheerleader to debate with the critic. Imagine what your best friends and biggest fans would say in response. Engage in an inner debate, don’t just agree with your critic, and you will begin to loosen its hold.

Recruit the critic. Ask yourself what the purpose of this inner critic might be. Inner reflection shows they tend to be afraid for us, want us to succeed, and want us to be motivated. You could start an inner dialogue with the critic and request that it find a better way to talk to you. As you would with a child, tell it to ask nicely for what it wants. Find a way to change its tune so it becomes more of an ally. Give it a name, learn its theme song, and listen only when the music sounds pleasing. Otherwise, change the channel, turn your attention elsewhere.

Attend to your dreams: your inner barometer

One of the most accessible ways to develop a rich inner life is to engage with your dreams. We all dream a feature film’s worth of dreams every night, although only a fraction is ever recalled. But if you pay attention to your dreams, write them down and ponder them, they become easier to recall and begin to speak to you directly from your deepest self.

Many people tell me they don’t recall their dreams, or if they do, they can’t make sense of them. One way to understand dreams is as picture-metaphors of whatever feelings are currently most important. Dreams are not meant to be understood as a linear story, but more as an image of your inner life. Spending time with the felt sense of the images in your dreams, drawing pictures of them, telling others about them and carrying them with you like an essential question will often open up the dream and bring you critical information from your authentic inner self. In short, do not ignore your dreams! Instead of trying to figure them out, let them come alive inside you, and ponder them as you would a poem or piece of art.

To sum up, we’ve covered three simple ways to engage more with your inner life. The first two suggestions are aimed at making it more attractive to look inside — since stress and the inner critic are two of the main reasons many of us prefer not to look inward. The third suggestion, to listen to your dreams, has the potential to open up a richly imaginative world that is a huge untapped resource in your journey toward your deeper self. Dreams regulate our emotions, point to what matters most, and can be our best guide on our life’s journey. They can also be funny, creative and compelling, all the more reason to go play inside.

For those interested in helping clients (or yourself) further to tame the inner critic and cultivate constructive and helping mind meandering, sign up for our free seminar online, coming Sept. 6.

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Daydreaming is Our Baseline State, Not Something to Avoid

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We spend half of our waking lives daydreaming. This may or may not be a good thing – it depends what your daydreams are like.

A Harvard study on daydreaming entitled ‘A Wandering Mind is an Unhappy Mind’ may be giving daydreaming a bad rap. In a culture dominated by a drive for productivity, there is a sense that allowing our minds to wander freely hampers focus and the ability to get things done. This is why derogatory terms such as ‘spacing out’, ‘intrusive’ or ‘non-relevant’ thinking and ‘cognitive control failure’ are used to describe this normal human activity.

Naomi Kimmelman presented these ideas at the recent conference for the International Association for the Study of Dreams (IASD). She suggested that it is the kind of wandering your mind does that determines whether it’s helpful or not. Renowned daydream researcher Jerome Singer differentiated three styles of daydreaming: positive-constructive, guilty-dysphoric and poor attentional control. Cleary, the first category is a helpful state to be in, while the latter two are not.

Much of the research into daydreaming has focused on its negative attributes, but one study (McMillan, Kaufman & Singer, 2013) examined the question, how can something we spend half our time doing be so bad for us? In fact, their review of the research shows that in the brain’s ‘default mode’ we are consolidating memories, planning, problem solving, being creative and making meaning of the events of our lives. The authors highlight a review by Immordino-Yang et al. (2012) that stresses the importance of ‘constructive internal reflection’ for the development of a range of social and emotional skills such as moral reasoning, empathy, compassion and meaning-making.

The main thing to note from the plethora of daydream research in the past decade is that daydreaming is not inherently bad or good, but rather, it depends on how you daydream. For example, one study (Mar, 2012) found that daydreaming about close friends promoted a sense of social support, while daydreaming about strangers emphasized feelings of loneliness. The ‘guilty-dysphoric’ type of rumination identified by Singer is associated with depression.

It is a paradox that how you allow your mind to wander matters, when by definition, it’s a state of mind we don’t control. However, awareness of such states and deliberate active imagination practices may allow our wandering minds to stay in the creative states that are so helpful. Of course, we need to strike a balance between daydream and focused attention so we are able to rein in our meandering thoughts when we truly need to focus on the task at hand.

It helps to know that we can only focus part of the time. In another conference presentation about dreaming in the context of work life, Dr. Rubin Naiman noted that our minds naturally go through an oscillation between basic rest and activity (BRAC), even when we are working. During a work day, we will spend perhaps 70% of the time in a left-brain-dominant task-oriented mode and the rest of the time in a more right-hemispheric dreamy state. There is no point or reason to fight this or to think of ourselves as ‘lazy’ or ‘unfocused’ if our attention drifts off about a third of the time. It is normal, and impossible not to daydream, even while at work.

Both presentations underscore the importance of and ubiquity of daydreaming – it gives us a mental break, fosters creativity and allows us to view the world with a larger perspective. It slips us into a state of being rather than doing, a state that as a culture, we might want to value more.  I will close with a quote by Cheri Huber that Naiman shared: Please don’t do yourself the disservice of thinking there is anything you can do that is more important than just being.

Want to learn more about how to ensure your mind wanders along creative and helpful paths, rather than down the spiral of rumination and worry? We are offering a free (pay-what-you-can) seminar on Sept. 6, 2023 at 10am PACIFIC – and it will available as a recording if you miss it or can’t attend live. 

References

Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932-932.

Mar, R. A., Mason, M. F., & Litvack, A. (2012). How daydreaming relates to life satisfaction, loneliness, and social support: The importance of gender and daydream content. Consciousness and cognition, 21(1), 401-407.

McMillan, R. L., Kaufman, S. B., & Singer, J. L. (2013). Ode to positive constructive daydreaming. Frontiers in psychology, 4, 626.

Singer, J. L. (1975). The inner world of daydreaming. Harper & Row.

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To Sleep Better, We Need to Surrender to Our Dreams

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A podcast review by Dr. Leslie Ellis

The main reason people don’t sleep is that they have a bad relationship with dreaming. – Dr. Rubin Naimin

 

I was so inspired by a recent conversation between Nikos Patedakis and Dr. Rubin Naiman on the Dangerous Wisdom podcast, I want to share some of their surprising and inspiring ideas —such as how befriending dreams can be the key to getting a good night’s sleep.

 

Sleep and dreaming are a different, and wider form of consciousness than waking. Many with sleep troubles fear falling into sleep and dreams because it means letting go of our accustomed waking state and the sense of self that comes with it, according to Naiman, a psychologist, author, Fellow in the American Academy of Sleep Medicine and clinical assistant professor of medicine at the University of Arizona’s Andrew Weil Center for Integrative Medicine.

 

We need to change how we think about sleep

Naiman consults internationally about sleep and dreams and believes patients with sleep problems are thinking about sleep in the wrong way. “The statement, ‘I can’t sleep’ makes no sense… because the presumption is that the part of me that I call ‘I’, the waking self, should be able to sleep, and it can’t. That’s where people get stuck, they try leverage waking to get to sleep.” In fact, our very efforts to fall asleep tend to engage our waking selves more deeply.

 

So how does he suggest we descend into sleep then? It’s more of an accident than a deliberate effort, and it takes a willingness to descend into a different state where our sense of self and ego are not as central, and there is a greater breadth of consciousness available. Naiman said that over the previous few decades, our collective consciousness has shrunk, in part a product of spending more time narrowly focused, indoors, and looking at various screens rather than the natural world. So when we begin to fall asleep, and dreaming begins to widen our horizons, we may feel overwhelmed.

 

Naiman said: “Sleeping and dreaming both require a fundamental willingness to allow consciousness to expand, but this may be something many are not comfortable with. A contraction of consciousness allows for the kind of focus essential to survival in the waking, material world. The problem is that if we stay there, we think that’s all there is.” He goes on to lament the current epidemic of sleep loss, which he says is actually dream loss, and that attention to dreaming is a glaring omission in modern sleep medicine.

 

“The main reason people don’t sleep is that they have a bad relationship with dreaming.” Naiman cites evidence that when those with sleep troubles are first letting go into the kaleidoscope of dreams and a dissolution of waking consciousness, they react to that “as if it were a stampede coming from the horizon.”

 

Psychedelics as an appetizer for expanded consciousness

Dreaming is a different order of consciousness, one that is both feared and repressed, but also sought after. Because we are being deprived of the mind-expanding properties of dreaming, we hunger for it. Naiman says this may be why there is such a resurgence of interest in psychedelics: “We have forgotten how to expand consciousness through sleep and dreams, so it makes sense we are fascinated that a molecule or mushroom can do that. I’m not opposed to that, but these are the appetizers, not the main course.”

 

Patedakis views mind-altering substances as a bridge but not the final destination: “You need to learn what your mind can do. And then you need to learn how to do it within yourself.” Both speakers advise proceeding gradually into wider ways of seeing and being because plant medicine can bring overwhelm and disorientation to those not prepared for a direct experience of expanded consciousness. As a culture, we have been taught to fear or dismiss such things.

 

Academic focus on the material world ‘distorts and impoverishes’ our self-understanding

Naiman quotes Gary Schwartz and a group of scholars lamenting the nearly absolute dominance of the material over the subjective in academic study. This has “led to a severely distorted and impoverished understanding of ourselves and our place in nature.”

 

Even those who practice mindfulness and other potentially consciousness-shifting activities often do so to become better in their waking life. They want to know what their dream means so they can apply it to their personal situation, missing entirely that dreaming reflects a much larger perspective, one that takes us beyond ourselves into a wider, more spiritual realm.

 

Dreaming as antidepressant

Naiman also speaks of the psychological importance of dreaming. “It processes, sifts, digests and assimilates waking experience. If we are not dreaming, we’re not assimilating, and we’re not being nourished by our waking experiences.” This could explain the well-known link between dream loss and clinical depression. Ironically, the medications to treat depression erode dreaming even further because most antidepressants suppress REM sleep.

 

The answer to the epidemic of depression and sleep loss, according to Naiman, is not to medicate the problems but to turn toward our dream lives and allow them to help us become more comfortable with a wider sense of who we are. “If we have a better relationship with the dream world, we definitely sleep better,” says Naiman.

 

Expanding Liminal Space, Extending Sleep

Building a bridge between waking and sleeping by dwelling in the in-between, the gradual transformation inward as night falls, is a natural way to drift into sleep. “In nature, sleep actually starts when the sun goes down and there is a beautiful, gradual transformation of consciousness through dusk, and also again through dawn.” Naiman suggests that we surrender to the night and to the dark, allow it to naturally expand our consciousness, and view it neither as inferior nor applicable to waking life. In fact, sleep and dream life is the larger vessel in which the narrower consciousness of waking is contained.

 

Below are the links to both Nikos’ interview with Rubin Naiman, as well my conversation with Nikos on experiential approaches to dreams (which is referred to in this interview).

 

Rubin’s podcast episode: https://dangerous-wisdom.captivate.fm/episode/recovering-sleep-and-dreams

Rubin’s YouTube link: https://www.youtube.com/watch?v=X_E4tyFw-8c

Leslie’s podcast episode: https://dangerous-wisdom.captivate.fm/episode/attending-to-our-dreams-dialogue-with-dr-leslie-ellis

Leslie’s YouTube link: https://www.youtube.com/watch?v=7NyYEd3neIg

 

References

Naiman, R. (2017). Dreamless: the silent epidemic of REM sleep loss. Annals of the New York Academy of Sciences, 1406(1), 77-85.

 

For more on experiential dreamwork for clinicians, visit www.drleslieellis.com

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Current Nightmare Treatment Research Roundup: Addressing Pre-Sleep States, Individual Differences and Co-Occuring Mental Illness

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Our state of mind and body prior to falling asleep can affect the way we dream, and this can be a target for treatment for those who experience frequent trauma-related nightmares. If you are someone who has trouble falling asleep because you can’t quiet your mind and body, you are also more likely to have disturbing dreams.

 

A recent study by Youngren and colleagues (2022) has replicated existing evidence that the time it takes to fall asleep (also called sleep onset latency or SOL) and pre-sleep cognition (such as worry or rumination) significantly increase nightmare frequency. Somatic arousal is also implicated, but the results are more complex – self-reported physiological arousal did not impact nightmare frequency. However increased arousal measured by the DREEM headband used to measure physiological aspects of sleep did significantly correlate with more nightmares. The subjective and measured arousal levels did not correlate; it seems participants were not reliable judges of their own physiological pre-sleep arousal.

 

The researchers tested a small sample of 15 male inpatient veterans who had experienced trauma and frequent nightmares. They were seeking to strengthen the evidence for their NIGHT-CAP (nightmare cognitive arousal processing) theory, which proposes that the longer it takes to fall asleep, the more time there is for negative pre-sleep worries to prime a person for negative dreams. However, while SOL and pre-sleep cognitions independently predicted nightmares, the interaction between the two was not significant.

 

The authors note the importance of their findings to clinicians because “current treatment options for post-trauma nightmares remain sparse and are less effective than treatments for other sleep disorders, such as insomnia.” The study results suggest that a bedtime ritual of calming the body and clearing the mind could potentially help reduce nightmares.

 

A complicated picture: How pre-sleep arousal affects dreaming

The effect of the body’s arousal level prior to sleep on subsequent dreams is not clear or linear, however. Another recent study (Dumser et al., 2023) highlights individual differences. In this study of 16 women with regular nightmares, fear of sleep was, when averaged, significantly linked with increased nightmare distress, but there were notable individual differences. Pre-sleep arousal also yielded highly individual effects on sleep and dreaming.

 

The authors concluded: “These findings highlight the crucial role of fear of sleep in the etiology of nightmares and sleep disturbances, while pointing to the importance of pursuing individual, personalised models that explain heterogeneity in the process of triggering nightmares.”

 

Nightmares and Psychiatric Illness: Co-occuring or Causal?

Nightmares are a cardinal symptom of post-traumatic stress injury and in this context, are becoming more frequently considered as a target for treatment. However, disturbed dreaming is also prevalent in other psychiatric disorders, notably depression, anxiety, suicidal ideation and borderline personality. Yet nightmares are rarely a target of treatment in these cases.

 

A recent systematic review of the effect of nightmare treatment on mental health issues (Sheaves, Rek & Freeman, 2023) highlights the scarcity of research in this area, but also some indication that treating nightmares has the potential to help with a variety of symptoms. They found treating nightmares particularly helpful with threat-based disorders, pointing to a causal relationship. Moderate reductions in PTSD, depression and anxiety were found as a result of nightmare treatment. There is also a surprising result from two pilot studies that nightmare treatment might prevent recovery from suicidal ideation, despite strong evidence linking nightmare frequency with subsequent suicide attempts.

 

This and all other areas of nightmare treatment are “greatly understudied” so firm conclusions could not be drawn from the existing evidence. The authors suggest it’s possible that rather than being causally related to many mental health problems, nightmares may instead share similar causes. In PTSD, however, the impact of nightmares on related symptoms is more clearly causal and also bi-directional.

 

I am offering a more comprehensive course for clinicians called The Nightmare Treatment Imperative. Learn why treating nightmares is both essential and surprisingly simplein this online course for mental health professionals, dreamworkers, and anyone who supports those with nightmares.

 

References

Dumser, B., Werner, G. G., Ehring, T., & Takano, K. (2022). Symptom dynamics among nightmare sufferers: An intensive longitudinal study. Journal of Sleep Research, e13776.

Sheaves, B., Rek, S., & Freeman, D. (2022). Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clinical Psychology Review, 102241.

Youngren, W. A., Hamilton, N. A., Preacher, K. J., & Babber, G. R. Testing the Nightmare Cognitive Arousal Processing Model. In press, Psychological Trauma: Theory, Research, Practice, and Policy.

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Dream Wisdom from Montague Ullman, Master of Dream Group Process

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Montague Ullman developed what is likely the most popular and democratic method of working with dreams in groups. Working with dreams in a group can open multiple avenues in a dream, deepen our capacity for empathy and illustrate how all dreams have archetypal dimensions that speak to us all.

(Sign up here if you want to hear more about joining a dream group this fall.)

The Ullman method is explained in considerable detail, with examples, in his book, Appreciating Dreams, a group approach (2006, Cosimo Publications, New York). I have gathered a sampling of some my favorite words of wisdom about dreams from Ullman to share with you.

 

On ‘Day Residue’

Ullman said the that events from the day that trigger our dreams are often not that important in their own right, but rather because, by association, they bring deeper emotional concerns closer to consciousness: “All of us are continually reworking unfinished emotional business from the past. Our dreams seem to be way stations along which these concerns pass, creating the possibility for recognition and exploration” (p. 21).

 

Do Not Dismiss Short Dreams

“A dream cannot be too short for the group to work on. This includes dreams that may consist of a single image. Even when only a small bit of a longer dream is recalled, it can have a holographic quality and touch on many aspects of the dreamer’s life” (p. 25).

 

Why Dreams Need to be Worked Through

Do not judge dreams from the point of view of the waking state as dull or unimportant. “Only when a dream is worked through its connection to the underlying emotional streams that enter into it, can its value be assessed. Its importance is seen not to lie in its appearance but in the channel it opens to the larger dimension of our being, seeking to make its presence felt” (p. 26, emphasis added).

 

On Metaphor and Bridging Waking and Dreaming Thoughts

“Awake, we do not think in the same metaphorical fashion as we do asleep. We do not ordinarily view our waking experience from the point of view of its potential for translation into visual metaphors” (p. 68) Ullman says the emotion that comes with dream images can help bridge the large gap between waking and dreaming thought. “It takes investigative effort to bring the dreamer close enough to the living feeling context of the period just before the dream.”

 

Dreams As a Direct Path to the Truth

“We all know what the truth feels like. Whether we embrace it with relief or recoil from it in pain, it feels real. Its very reality provides us with the opportunity to engage with it and grow in our struggle to come to terms with something new about ourselves. Dream work is a very direct way to provide us with such opportunities” (p. 95).

 

On Offering “Orchestrations” to the Dreamer

In the final stage of his dream group process, Ullman asks group members to take in all that has been said about the dream and offer comments that ‘harmonize image and reality’ as a way to ‘separate the melody from the cacophony of sounds that have filled the air’.

“Coming to an orchestrating idea that really moves the dreamer is an interplay of intuition, the ability to listen to a dreamer and discern the appearance and flow of feelings, openness to that material the dreamer has shared and all that has been shared, and finally, sensitivity to metaphor” (p. 95).

 

‘Stumbling blocks in the path of our evolving maturity’ that often show up in dreams:

  • How well do we handle feelings such as anger on the one hand and tenderness on the other?
  • How susceptible are we to feelings of guilt, self-depreciation and self-denial?
  • How aware are we of our own need for nurturing and support?
  • To what extent are we oriented to the needs of others at the expense of our own needs?
  • To what extent do we blindly accept personal, social, and institutional arrangements that limit or do violence to our own humanity?
  • To what extent do we deny or suppress what it truly alive in us?
  • To what extent are we being carried along passively by the tide of our life? (p. 97)

 

What’s notable about this list is that it suggests dreams encourage us to advocate for our own self in various ways: accepting one’s value, finding what is ‘truly alive in us’ and becoming active agents of our own lives. It might be in interesting line of inquiry for your next dream: how is this dream encouraging me to advocate for myself and to live a life that is in keeping with my deepest desires?

 

Are you interested in further dream group study with Dr. Leslie Ellis? Do you want to be part of a small, dedicated dream group starting in fall 2023? There will be limited space, so please add your name to this list if you want to hear more about this opportunity.