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What Can You Do About Your Nightmares? Ideas from a trauma expert

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There is a lot you can do, and some compelling reasons why you should take action to quell your nightmares, especially if you suffer from post-traumatic stress injury

Tom is awakened with a start by the sound of his own screams. Several nights a week in his dreams, he revisits the burning building, and hears terrified voices from inside, above the roar of the flames. The building has been deemed unsafe, he can only watch in frozen terror as the heavy beams start to fall and the building collapses. This is not an actual memory, but a condensation of all the times in his career as a firefighter that he arrived on the scene too late to save someone. Now, these memories haunt his dreams, and bring a deep sense of despair. What most people do not realize is that you do not need to simply suffer them; there is something you can do about nightmares.

Not all nightmares are a cause for concern

Nightmares plague almost all of us at different times in our lives. For the most part, this is not a problem, even though such dreams can be distressing. But if your nightmares cause significant distress, wreak havoc on sleep and adversely affect how you function during the day, it is really important to do something about your nightmares. About 5% of the general population and 30% of those with some form of mental illness fall into this category.

Researchers have established a clear link between nightmares and suicide, so if you have both suicidal thoughts and nightmares, you need to take action. Fortunately, what many people don’t realize is that there are many effective treatments for nightmares and they involve fairly simple steps. (If your therapist does not have training in nightmare treatment, some accessible online resources are listed below.)

Talking about your nightmares helps

Too few people talk about their nightmares; there is a tendency to think this wouldn’t help. Or that those you tell will judge you. Neither is true, and it really helps to talk about nightmares. Nadorff has studied nightmares extensively and concludes that “nightmares are a robust and modifiable predictor of increased suicidality and poor psychiatric outcomes” (2015, Journal of Clinical Sleep Medicine).

The good news is that nightmare treatment appears to work for many people. The research has raised many questions about what exactly is working and why, but it seems that almost anything that researchers have tried has the potential to make a difference. It may be that simply knowing nightmares can be treated opens the doorway to change.

Nightmare rescripting is the common denominator

There are many elements that have been incorporated into nightmare treatments. One of the most common is called nightmare rescripting. This is simply the process of coming up with a new ending to your nightmare. In the well-researched treatment modality called Imagery Rehearsal Therapy, people are asked to change their nightmare in any way they want, and then to imagine this new version a number of times before going to sleep. The research has shown this to be very helpful for many kinds of nightmare sufferers, from veterans to rape victims.

There are many variations on this treatment, and all appear to be helpful. I found in my practice that teaching clients to imagine a new ending to their nightmares is something they can do on their own, at home right when they wake up from a frightening dream. This gives them a constructive action to take, a way of calming down. They tell me it gives them a sense of control over their distressing dreams and takes away some of the fear of going to sleep. What is also good about such nightmare treatments is that they can not only help reduce nightmare frequency and distress, but they also reduce daytime symptoms of posttraumatic stress injury – things like flashbacks and a tendency to avoid situations that can trigger them. The other good news about most of the nightmare treatments studies is that treatment is quick, can make a difference in a session or two, and even if doesn’t help as much as you would like, the studies reported few if any adverse effects.

What to do when you wake up from a nightmare

When you are jolted out of sleep by a nightmare, your body will likely be quite amped up. So take a few minutes to let your heart rate and breathing slow down. Remind yourself gently that this was just a dream, and that it is not happening now, real as it may have seemed a few moments ago. Take a few long, deep breaths, extending the exhale to calm your nervous system. Calm your emotions by picturing in detail one of your favorite places or imagining someone you love deeply and amplifying the feelings you have about them. Look around the room for something comforting and to remind yourself you are safe in your bedroom, not back in the dream.

Once you feel calmer and better, go back to your nightmare images, just the very last part of the dream that woke you up, and allow the dream to play forward from there in any way you want. It does not have to come to a tidy resolution, although it might. Just let the dream play forward to find a better stopping place. Keep your breath slow and regular. What most people find is that this simple practice changes the dream for the better and gives the dreamer a greater sense of control and safety.

Nightmare changes can indicate trauma recovery

When I have treated patients with nightmares in a similar way to what is described above, I found that all of them experienced some kinds of changes in their dream life. Sometimes the nightmares stop altogether, but more commonly, they begin to change and start to look more like normal dreams – they are a bit stranger, more a of mix of past and present, and less of a direct replay of a trauma memory. This is an indication that the process of healing has begun.

When a traumatic event has not been metabolized, it can come back in the form of recurrent dreams that either represent or replicate the actual trauma event. The more the dreams of the trauma begin to weave in elements from current life, the closer the dreamer is to having integrated their trauma. The nightmares may not stop right away, but if they shift and start to feel more like normal dreams rather than repeated replays, this is a good sign.

Resist the urge to avoid treating nightmares

Both therapists and those who suffer from nightmares might be tempted to back away from conversations about their alarming content. But if you are suffering from the same kinds of terrifying dreams most nights, it is a mistake to think not talking about it will help in some way. It does not. Talking about it helps, even when the subject matter is intense.

Philosopher Eugene Gendlin said it this way: “What is true is already so. Owning up to it doesn’t make it worse. Not being open about it doesn’t make it go away… People can stand what is true for they are already enduring it.”

Current research has shown that even with the most unbearable trauma, such as those who were inmates of Auschwitz, it is better for survivors to talk about their dreams than try to bury them. A Polish researcher, Wojciech Owczarski, studied 500 dreams of 127 former inmates and found that only 10 percent are still suffering from recurrent dreams that replicate their trauma. He found that all the dreams had “therapeutic potential” either on their own or with the help of a therapist.

To wrap up, there are many reasons to talk about your nightmares, to rescript them, and to seek treatment if they cause you significant distress. These challenging dreams can be seen as your own body’s attempt to integrate the trauma you have suffered, but to realize this helpful effect, you must work with the dreams rather than avoiding them.

 

As a small gift to those who suffer from nightmares, I have made a free 7-minute self help video, dedicated to first responders and front-line workers. For those clinicians who want more information on treating nightmares, consider taking my online course: Nightmare Treatment Imperative.

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Dreaming in Times of Collective Crisis: A nocturnal perspective on Ukraine

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Recently I dreamt I was standing on a rocky, mountainous ridge, the stone an iron colour, like dust mixed with blood. I am looking for a way down, and all the options seem treacherous. Suddenly, the ground begins to split under my feet, a massive slice of it neatly dropping away. It feels as if this has destabilized everything around me, as if the earth’s crust has suddenly lost its integrity. I am left in a state of expectant waiting-for-disaster and not sure what form this will take. To me this dream clearly speaks to the devastation I feel as I watch, with the rest of the world, as the horrifying events of the Russian invasion of Ukraine unfold.

Like the recent global coronavirus pandemic, the war in Ukraine is an event that affects us all. It has destabilized the world and divided countries along ideological lines, which has the frightening potential of leading to a much larger war. The pandemic clearly infiltrated the world’s dreams, increasing dream recall and disturbed dreaming, and introducing themes related to health, loss of freedom, invisible threats and death. A number of studies have documented this global phenomenon, lending support for the continuity hypothesis that suggests that waking-life concerns find their way into our dreams. The same holds true for the way war now unfolding is infiltrating our collective dreaming.

In a recent and poignant session with one of my dream classes, I wanted to take a moment to acknowledge the harrowing events in Ukraine. I shared my dream and the personal nature of the war for me. Half my ancestry is a mix of Ukrainian, Russian and Polish. The borders have changed so much in the areas where my mother’s family originated that the same area was at times Russian, Ukrainian or Polish. The epicenter, according to my ’23 and Me’ ancestry test, is at Lviv, now part of Ukraine, part of the area that is being systematically reduced to rubble.

My dream of the ground splitting under my feet feels like a direct response and an apt metaphor for what is happening in Ukraine. This war feels very close to home, destabilizing and so much bigger than me. Others in the dream group, and in other dream circles I tend, have been reporting similar themes: dreams of invasion, of violence and displacement.

One poignant example was a recent dream offered by Theresa, her in-laws having immigrated over 50 years ago from what is now the Ukraine, Germans fleeing from the Russians. Recounting the dream, she said, “I am at my mother’s house. Looking out from the second-floor deck (of my current home), I see the new neighbour with his teenage sons looking towards me. They have torn down the fence and stripped my mother’s backyard of all its’ bushes and flowers. One tree remains, an apple, with only the trunk left standing. Now I find myself in my mother’s basement, the neighbour there with his boys, though younger in age. The room is wild, toys spread chaotically everywhere. I ask the one boy to clean up his mess and he defiantly refuses. I go upstairs to ask his father, the neighbour, and my husband, for help. By the time we return to the room, the toys are cleaned up and the other children confirm the young defiant one has helped…”

Many in the group could relate to the themes of invasion, destruction and utter disrespect of boundaries in the dream. There was a collective sense of grief, sadness and frustration expressed. However, the dreamer is given the last word in this dream process and Theresa said she ultimately saw this dream as one of reconciliation, the coming together of warring parts that have entered the foundation of her mother’s home; an invitation to have all take part in the commitment to a better way.

Recounting the dream brought deep and surprising emotion for the dreamer. Theresa said that her dream invited process at the collective as well as personal level, speaking to the situation in the Ukraine, and her life. She recognized the dream was showing her the power of our own ‘sacred motherland’ and at another level, the strength of the archetypal divine feminine to stand loving and firm while holding chaos and destruction. She felt the dream was hopeful in that her call for help was answered by the two adult men, as well as the children. One apple tree was left standing, the potential for regrowth still present. (The biblical symbolism of the garden of Eden is not lost on us.)

When I had my dream of the ground splitting, or when someone brings a dream of invasion and destruction, I wonder, as I am wont to ask, what is helpful about such dreams?

For the dream groups I am hosting, discussing dreams in times of crisis gives us a venue to feel and express our concerns and the deep emotion that has been stimulated by world events. We can hold each other in our grief and sorrow. Many of us have been given an image or a metaphor for our deep unexpressed feelings. This does not solve the larger problems, but it does make us feel less alone with them and it prompts action, in whatever ways we can offer help.

That world events can infiltrate our dreams makes sense because intense emotion is the fodder of dreams. World crises are changing our dreams collectively, demonstrating how we are all in this together. Information travels fast, and no longer do massive humanitarian crises take place in secret. My hope is the increasingly collective nature of world events can begin to sow the seeds of peace.

Near the close of the dream group, one member, through her tears, spoke in response to Theresa’ dream, “The devastation image was so immediate and resonant of Ukraine, and then Theresa brought such compassion to it. If we are going to dream our mutual dream of the human race forward, this is what will lead us.”

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Nightmares and the Nervous System: A new way to understand and treat nightmares

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In the world of trauma therapy, a paradigm shift has been taking place over the past decade or so, a marked shift toward embodied and somatic approaches to the understanding and healing of trauma. The polyvagal theory by Dr. Stephen Porges has led clinicians to consider that much of what was previously viewed as pathological behaviour can be seen as adaptive responses that our client’s autonomic nervous systems (ANS) have initiated as a means of protection and survival. This hopeful and non-shaming approach has changed the way trauma therapy is practiced for so many… yet the paradigm shift has not found its way into the treatment of nightmares. I feel that it’s high time for this to change because nightmares deserve clinical attention. They are a cardinal symptom of post-traumatic stress injury, and associated with complex trauma, anxiety, depression and many other mental health challenges. They have been strongly correlated with increased suicide risk.

I have been doing my best to help more clinical attention to nightmares and opportunities for training. I have spent the past several years developing a theory and treatment protocol for nightmares that takes the polyvagal theory into account. This work is the basis of a major article (now under review) and two online courses on nightmares, one for clinicians and one for the general public. I am consistently sending the message that nightmares are urgent messages from the body, attempts at trauma recovery and at getting the dreamer’s attention so they can attend to underlying sense of threat that haunts their nights. Nightmares are treatable, yet so often they are not treated. And in the   most serious cases, where they may lead to greater suicide risk, I believe treatment is imperative.

 

Nightmares reflect a nervous system that doesn’t feel safe

One of the most freeing aspects of Porges’ theory is the idea of ‘neuroception’, which is the internal sensing process which happens automatically, outside of conscious awareness, as our bodies pick up cues of threat and safety from the environment and react accordingly. The theory states that our autonomic responses happen in a specific order – first with activation to fight or flee from danger, and second with immobility or shutdown when fight or flight are not possible or advisable. Shutdown in the face of an overpowering aggressor may in fact be the wisest choice, though it is completely out of conscious control. Knowing this has helped rape survivors, for example, understand why they went limp and didn’t fight back, an action their own body deemed would put them in even greater danger. This knowledge reduces their sense of shame.

 

Nightmare content reflects the autonomic nervous system

Something interesting I noticed in working with nightmares over time is that the content of these dreams often reflects the various states ascribed to nervous system responses. The vast majority of fear-based nightmares depict scenes of being chased or running away (flight), of being faced with agression (fight) or of a sense of frozen hopelessness and inability to move (immobility). It is as though our dream content is describing our autonomic state. The beauty of this is that it is not static, but can shift and change in response to cues from the environment.

Porges has stated, quite simply, that when in comes to trauma and resulting ANS reactions, “safety is the treatment.” I have found that with frightening dreams, if you can instil a sense of safety in the dreamer, either within the dream itself, or after that fact in working with the dream material, it can shift even long-term recurrent nightmares, sometimes permanently. Too often I have seen that nightmare sufferers feel like victims of the terrifying dreams, thinking there is nothing they can do, making them fear sleep itself, which is ideally a balm and a time for deep rest and recovery.

 

Not all nightmares are the same

One thing that the polyvagal theory has helped me to understand is that there are two distinct responses to trauma and adversity – one is highly activated and the other is more dissociative. The pathway to safety and recovery from these two states is different, yet most nightmare treatments are applied as if they are all the same. When a person’s body reflects collapse or immobility, what the polyvagal theory states is that they are very far from being able to engage with someone who is trying to soothe or help them because they have turned inward and their social engagement system is shut down. Porges says the path back from this state is longer and more complicated and needs to pass back through the activated state most of us associate with trauma.

In either case, instilling a sense of safety and then of connection will help shift the dreamer’s state, and often, the memory of this stays with them when they next encounter the fear response within their dreams. This is why the popular nightmare treatment method of ‘rescripting’ or rewriting the content of one’s dreams can be so powerful. When we revise our dream narratives, we can add empowerment, help from others, a new way of seeing the situation that renders it less threatening… or anything that feels right to the dreamer.

In my work with dreams and nightmares, I always ask the dreamer to find and then embody any aspects of the dream they find helpful – and to imagine the dream forward to include such elements if the dream itself contains no such sources of support. When they experience a sense of power, of safety and of company in the face of their haunting dreams, these dreamers often hold on to it, and the potential for a helpful shift is available to them next time they have a similar dream. This brings hope and change to places that felt frozen in place, the beginning of a new and more empowering relationship to one’s embodied dreams.

 

Do you know someone who suffers from frequent nightmares? Or are you a parent concerned about the frequency and intensity of your child’s bad dreams?
Learn why treating nightmares is both essential and surprisingly simple in these two online course about nightmare relief.
Nightmare Treatment Imperative – The complete course for Clinicians
Nightmare Relief for Everyone –  A little course designed to help everyone
Learn how to treat nightmares with evidence-based methods!

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Treating Trauma and Addiction with the Felt Sense Polyvagal Model: A Bottom-Up Approach

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A timely and compassionate book on treating trauma and addiction using the Felt Sense Polyvagal Model.

Just at a time when the wider world is waking up to a more compassionate and inclusive way of understanding trauma and addiction, a timely book that addresses these issues in personal, historical, embodied and practical ways has arrived. In Treating Trauma and Addiction with the Felt Sense Polyvagal Model: A Bottom-Up Approach (Routledge, 2021), author and psychotherapist Jan Winhall both demystifies and depathologizes addiction. She does so by demonstrating in theory and with compelling case studies how addictive behaviours are in fact resourceful attempts to regulate a body that has been thrown out of homeostatic balance by traumatic experience.

Winhall’s new book incorporates both focusing and the polyvagal theory to create a treatment model for that is both effective and humane. It’s a model to help those afflicted with addictions and other effects of trauma understand their own physiological and emotional responses, and begin to take steps toward change that are both self-compassionate and doable.

Winhall explains how addiction is a propeller of neurophysiological state change, and in doing so, she solves the mystery of addictive behavior that puzzled her so much as a young therapist. She begins her book with the compelling story of her first women’s group and the mystery of their deeply self-harming behaviors. At the time, she simply couldn’t understand why this fascinating group of young incest survivors would engage in such self-destructive acts. Rejecting the idea that they were simply damaged, broken and ‘borderline’, Winhall went on a decades-long hunt for a more compassionate understanding of how to help these women heal.

A consistent thread through the book is Jan’s story of her own development as a trauma therapist, and it illustrates the evolution of ideas about the etiology and treatment of trauma over the past 40 years. Early influences include Bass and Davis’ The Courage to Heal, and Judith Herman’s classic, Trauma and Recovery. Add to this mix a deep understanding of Eugene Gendlin’s focusing, which brings a way to listen to the body in a way that assumes it knows the way forward. Stir in a healthy grounding in Dan Siegel’s interpersonal neurobiology, Bowlby’s attachment theory, the compassionate views of Gabor Mate, the relational wisdom of Harville Hendrix and Helen LaKelly Hunt, and finally, the updated understanding of the nervous system’s response to threat and connection as proposed in Stephen Porges’ polyvagal theory.

When you combine all of these embodied, compassionate approaches to working with trauma and addiction, what emerges is a model that stands in stark contrast to the medicalized version which pathologizes those who have already suffered so greatly. As Jan so aptly demonstrates, those who have suffered trauma and subsequently engage in a range of addictive behaviours are not broken, but in fact, doing their best to manage their pain and overwhelming emotions in the ways that are most available to them. It reframes their stories from tales of illness to journeys of triumph and liberation.

Winhall’s definition of addiction is a simple and non-judgmental one: “It helps you in the short term, hurts you in the long term, and you can’t stop doing it.” However, the historic view of addictions is not so kind. Winhall leads the reader through a history lesson that shows how the war on drugs, and the controversial evolution of the ‘disease model’ of addiction has led to racist and pathologizing ways of viewing addictive behaviour. It has also prompted many resilient trauma survivors to view their own attempts at self-regulation as shameful and bad, an attitude that hampers their recovery.

The Felt Sense Polyvagal Model

Over her many years of working with those who have suffered from trauma, and with a naturally compassionate and inquiring approach, Winhall has developed a model that makes sense of addictive responses that alleviates blame and shame, and replaces it with ways that clients can make sense of their own shifting states. Through a clear, graphic diagram of the physiological states described by Porges’ polyvagal theory, and guidance on how to map one’s unique pattern of experiences onto this chart, clients can begin the make sense of their own behaviours. They are then offering tools to help them decide how to take systematic and doable steps toward changing those behaviours that are most hurtful in the long term into more healthful ways of managing intense states.

Winhall has included both a detailed model for clinicians and a simplified one for clients in the book as a visual aid for understanding patterns of behaviour that can readily be reframed from addictive to adaptive. In addition, she offers a detailed Embodied Assessment and Treatment Tool (EATT) and a comprehensive list of focusing-oriented strategies that can be tailored to particular clients and their unique challenges. There is also a version for couples, and a lovely case study of how these tools led a couple struggling with the impact of childhood sexual abuse toward deeper connection, understanding and mutual compassion in the face of the painful experience of sex addiction.

Focusing and Thinking at the Edge

Focusing, developed by Eugene Gendlin, is another thread that runs through this book, and is a foundational practice for Winhall. She takes us back to her first meeting with ‘Gene’, as he is affectionately called, and the ways in which his conception of the felt sense brought all of the pieces of the puzzle together for her. She writes, “The felt sense contains the whole of our experiencing, including content and process, thinking and feeling: the sweet spot of integration.”

Winhall’s book not only contains a primer on focusing concepts and their rich underlying philosophy, but also practical examples and many places in the book that invite the reader to pause, check inside, and engage in the material in a focusing-oriented way. In this way, the book is an example of what it describes, a personal journey into the heart of addiction and trauma that invites an embodied response to the material, not just an intellectual one.

In travelling this journey that Winhall takes you on, weaving historical and factual information with personal vignettes, and poignant case studies told with the mastery of a novelist, there is another enduring theme that emerges: one of consilience. What we see, over the course of this immersive journey, is how all of these ideas are related, how they are often different ways of saying the same thing. This makes sense: we are all human beings, sharing the same basic emotions and responses, and Winhall helps us see how we are truly all in this together. Addiction and responses to trauma are not something ‘out there’ that only ill and damaged people engage in. Rather, we are all ‘shaky beings’ (to use Gendlin’s phrase) that are doing our best to self-regulate, to engage in life, and if needed, to liberate ourselves from patterns of behaviour that were brilliant solutions at the time, and may need updating.

The FSPM teaches us all how to identify our autonomic states, to feel into them in the moment and to understand what drives them. It teaches us how to deepen into our own experience and to subsequently guide others into this inner terrain in ways that feel safe and respectful. It moves us from a medical model to one of both self and co-regulation, from framing responses to trauma as acts of triumph and courage rather than freakish acts of self destruction.

This book reads like a story that begins and ends with Winhall’s first women’s group, and her lifelong drive to understand and help these women heal. She offers the example of Bridgette, who was convinced she was a ‘freak’ because of the times she would awaken from a dissociated state to find she had taken a razor to her own vagina. Winhall speaks of how she knew, even before she had fully articulated her model, to ground and connect Bridgette and to ‘validate and celebrate’ her body’s response to trauma, to see it as a way to release the pain and shift away from an unbearable state.

Jan writes, “As I explain this new way of understanding, her face opens. She looks around and see the women in the group riveted by her journey. It is their journey too. Looking incredulous, her jaw drops, and she lights up. Bridgette moves from feeling like a disordered person to a hero who made it through living hell. It is a moment of liberation, a profound shift that changes everything. These moments of liberation, arising out of a system that shames and pathologizes, are the heart of transformational healing. I pause here inside. These are the moments that I live for in the work.”

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Riding the Waves

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A shift in dreaming patterns from the first to second wave of the COVID-19 pandemic

A year and a half ago, as the full scope of the pandemic that was descending on us became apparent, there was a global increase in severe stress, worry, fear and uncertainty. Reports of heightened dream recall and dream vividness were also on the rise, with many experiencing nightmare-like depictions of their greatest pandemic fears realized. This was a time of great upheaval and dysphoria, or, as Harvard professor and dream researcher Dierdre Barrett put it, “an extraordinary time in the history of dreaming.” Global dreaming trends can give us crucial insight not only into our collective mental state, but into how times of crises are reflected in our dream lives.

In Wuhan, a study of 100 nurses working on the front lines found almost half were experiencing nightmares (Tu et al., 2020) and an online survey of 811 individuals reporting dream content found 55% had pandemic-related dream content (Pesonen et al., 2020). As the first wave of the pandemic subsided, dream reports began to decrease. Many reported a “return to baseline” in both dream recall and emotionality (Scarpelli et al., 2021). But we all know this isn’t where the story ends.

Enter the delta variant, causing more infections and spreading more rapidly than its predecessor, plunging many countries into a second wave. So what happened to our collective dream lives during the second wave? Researchers are now sharing their answers.

In the spring of 2020, Scarpelli and colleagues released a web survey to “collect socio-demographic information, psychological and sleep measures, and dream variables” from participants in Italy. Then the second wave hit Italy in October of 2020, giving Scarpelli and colleagues the unique ability to conduct a longitudinal within-subjects study of oneiric activity in different stages of the pandemic.

The researchers released a second survey to the participants of the previous survey, designed to investigate dream changes during the second wave compared to the first wave of the pandemic, and 611 participants responded. They asked about dream recall frequency, nightmare frequency, lucid dream frequency, emotional intensity and nightmare distress. Interestingly, all variables, both quantitative and subjective, were lower in the second wave, yet the emotional tone of the dream content was more negative. Essentially, people are remembering their dreams less, apparently dreaming less, yet the dreams they do have are more negatively toned.

The Scarpelli study was not the only one that who found this. Conte and colleagues (2021) showed that “reported dream emotional tone became significantly more negative both in total lockdown and partial lockdown (second wave) compared to previous periods.” In addition, they found that waking mood was much more negative and fearful during the second wave. Since pandemic dreaming has largely been supporting the ‘continuity hypothesis’ that our dreams reflect waking life concerns, this suggests an over dip in mood and increase in fear which may reflect the fact that by now, most of us believed we would have put COVID-19 behind us. Instead, it seems increasingly unpredictable and lasting, and many people are losing patience and hope.

Each wave in each country hits the residents differently, and everybody rides the waves in their own fashion. Yet, after the devastating effects of the first wave in Italy, it is not difficult to imagine how facing a second wave could elicit negatively toned dreams in Italian residents. A German study by Moradian and colleagues found that during the second wave, participants had more depressive symptoms and exhibited less safety behaviours (such as handwashing and mask wearing), which they believed was evidence of  “pandemic fatigue.” Another study by Kimhi and colleagues found that facing a second wave, participants had reduced resilience. After the shock of the initial wave, it appears that people are facing the second wave with a more resigned and negatively toned attitude, and this is what second-wave dream content reflects – less intensity but increased negativity.

With the dissemination of effective vaccines, it appears the waves of new infection have subsided from tsunami scale to a much more manageable level, especially among vaccinated populations. But vaccine availability and uptake is variable, and the waves continue to roll out in an unpredictable fashion, making this challenging time a kind of ongoing global experiment. The initial shock of the pandemic elicited such a strong shift in our collective dream lives that it spurred the publication of dozens of studies looking into dreams. Hopefully as the degree of disruption subsides, our shared interest in dreams will remain.

Do you know someone who suffers from frequent nightmares?
Or are you a parent concerned about the frequency and intensity of your child’s bad dreams?
Learn why treating nightmares is both essential and surprisingly simple in these two online course about nightmare relief.
Nightmare Treatment Imperative – The complete course for Clinicians
Nightmare Relief for Everyone. A little course designed to help everyone!

References

Kimhi, S.; Eshel, Y.; Marciano, H.; Adini, B. (2020). A Renewed Outbreak of the COVID−19 Pandemic: A Longitudinal Study of Distress, Resilience, and Subjective Well-Being. Int. J. Environ. Res. Public Health, 17, 7743.

Moradian, S., Bäuerle, A., Schweda, A., Musche, V., Kohler, H., Fink, M., Weismüller, B., Benecke, A. V., Dörrie, N., Skoda, E. M., & Teufel, M. (2021). Differences and similarities between the impact of the first and the second COVID-19-lockdown on mental health and safety behaviour in Germany. Journal of public health (Oxford, England), fdab037. Advance online publication.

Pesonen, A.-K., Lipsanen, J., Halonen, R., Elovainio, M., Sandman, N., Mäkelä, J.-M., Antila, M., Béchard, D., Ollila, H. M., & Kuula, L. (2020). Pandemic dreams: Network analysis of dream content during the covid-19 lockdown. Frontiers in Psychology, 11.

Tu, Z. H., He, J. W., & Zhou, N. (2020). Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study. Medicine, 99(26), e20769.

 

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Dreaming with our hearts as well as our minds

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New research uncovers a brain-body network that creates our dreams

So much of the research into how and why we dream has focused on the brain rather than the body… with the possible exception of nightmares where physiological fear responses are clearly a part of the experience. My sense of dreaming has always been that it is deeply embodied, and dynamically responsive to both our thoughts and emotions in an intricate dance. This may indeed be the case as a team of Italian researchers propose activation of the brain-heart axis is a trigger for dreaming.

New research led by Mimmi Nardelli has uncovered what I have always suspected was there: a body-mind link that drives dreaming, a bi-directional link where the body affects our dreams, and our dreams affect our bodies. The research team at the University of Pisa performed a comprehensive analysis of physiological signals during dream-rich REM sleep with nine healthy dreamers tracking brain and nervous system dynamics associated with dream recall. They also looked at causal directions not just correlations. They concluded that “bodily changes play a crucial and causative role in conscious dream experience during REM sleep.”

Much of the physiological dream research conducted to date has focused on neural correlates of dreaming, but this study also examines its relationship with the central and autonomic nervous system using measures of heart rate variability and blood pressure, along with EEG (brain) signals. Heart rate variability is a reliable measure of the state of the autonomic nervous system, which governs the body’s responses to cues of threat and safety. Blood pressure can also indicate levels of sympathetic activation.

The authors of the study noted that previous studies of nervous system correlates focused on discriminating sleep stages – for example, several studies investigating heart rate variability dynamics found a shift from vagal to sympathetic activity during REM. According to the Polyvagal Theory developed by Stephen Porges, this would indicate a shift from a sense of safety to one in which the body mounts a response to threat. This study goes beyond study of sleep stages to uncover new information about the relationship between dreams and the body.

During the experiment, researchers woke participants up during REM sleep and asked about their dreams – did they recall one, and was it positive or negative? They captured physiological data from the minutes prior to awakening and compared instances of dream recall with those where no dream was recalled.

Dreams and emotions linked

Previous studies have shown that in dreaming, the right hemisphere of the brain, more associated with visuo-spatial functiong and non-conscious emotional perception, is more active during dreaming, while activity in the left frontal hemisphere, associated more with logic and executive functioning, decreases. These finding were supported in this study. With respect to heart rate variability, when a dream was recalled,  an overall increase in sympathetic activity, and parallel decrease in vagal activity, was observed. The authors speculate that these findings indicate emotional arousal during dreaming.

In their study of changes in the nervous system over time in relation to dreaming, the authors found evidence to support a long-standing ‘activation-synthesis’ theory by Hobson and McCarley (1977) that dreaming arises from sensorimotor information relayed from the brain stem to the cerebral cortex. The current study suggest this is only half true. They found a bi-directional influence – a dynamic interchange from body to brain and brain to body.

The researchers wrote: “Results from the heart-to-brain interaction analysis suggest that the interactions between CNS and ANS associated with dreaming experience are bidirectional and exhibit dynamic changes.” They are quick to point out the results are preliminary because the sample size was small and low in statistical power. However, the study points to something I have come to believe about dreams: that their images are a picture of our embodied emotional state that impacts us deeply – and that we can also impact our dreams and how they unfold. They respond to us and we to them.

 

References

Hobson, J. A. & McCarley, R. W. (1977). The brain as a dream state generator: an activation-synthesis hypothesis of the dream process, The American journal of psychiatry.

Nardelli, M., Catrambone, V., Grandi, G., Banfi, T. (2021). Activation of brain-heart axis during REM sleep: a trigger for dreaming. American Journal of Physiology – Regulatory, Integrative and Comparative Physiology. https://doi.org/abs/10.1152/ajpregu.00306.2020

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Do Animals Dream?

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Three kinds of evidence to suggest they do!

Everything that makes us what we are, from the structure of our limbs down to the arrangement of our cells has been selected to give us an advantage over thousands of years of evolution. So, by this logic, dreams must increase our chances of survival in some way. The nocturnal movies we experience every night can be funny, terrifying, at times enlightening, at times just plain nonsensical. Yet they do appear to serve a purpose beyond mere entertainment, terror, or confusion. Dream researchers are uncovering their crucial role in memory consolidation, fear extinction, and emotional regulation. Yet this begs the question, where in the branches of the evolutionary tree does dreaming start?

If you have a pet, I’m sure you’ve seen them shifting their paws and growling while asleep, as if chasing a squirrel in their dreams. Believing a dog – or any mammal for that matter – can dream does seem plausible. But what about birds? Or octopuses? The great dilemma of animal dreaming lies in the fact that they are unable to communicate verbally to actually tell us about their dreams. But does this mean that the study of animal dreaming is truly inaccessible to science?

A recent article (Malinowski, Scheel, and McCloskey, 2021) explores this very concept. The authors propose three different non-verbal lenses through which we could study animal dreaming, including dream-enacting behaviours, neural correlates of dreaming, and replay of newly acquired memories. Let’s dive in!

Dream Behaviours

Dream-enacting behaviours describe the sleeper physically re-enacting a dream behaviour. When we sleep, our bodies are in a state of paralysis. Our partners should be grateful for this as it keeps us from thrashing them as we fight a dreamed enemy! While we don’t enact the bigger movements in our dreams, our bodies do have detectable physiological responses that directly correlate to dream content. For example, LaBerge (1986) found that smooth eye movements during sleep correlate with visually tracking something in a dream, and that dreamed-of sexual activity can lead to orgasms! In essence, our bodies respond to our dream content.

Individuals who report themselves as “non-dreamers” have been observed exhibiting dream-enacting behaviour, indicating that they do dream, but without recall. They classify themselves as non-dreamers because they cannot make verbal reports of dreaming, yet behavioural evidence indicates they do, in fact, dream. The inability to describe a dreaming experience, therefore, cannot be sufficient evidence that an individual does not dream. By this logic, we cannot classify animals as “non-dreamers” simply because they cannot tell us of their dreams.

In 1979 Michel Jouvet conducted a series of experiments on cats in which he “turned off” the part of the cat’s brain responsible for sleep paralysis. He observed that during REM sleep, the cats would begin to display dream-enacting behaviours. They would move as if stalking prey, play or begin to groom themselves. Their eyes remain closed and they did not respond to any visual stimulus, their movements appeared to be entirely oneiric. The movements would stop when the cats returned to slow-wave (or non-REM) sleep. Medeiros and colleagues (2021) have also observed octopuses exhibiting dream-enacting behaviours. They found that during sleep, octopuses would vary ventilation rates, move their arms and change their body patterns in ways unrelated to their surrounding environments. If you’ve seen My Octopus Teacher, you would not find it hard to believe octopuses have sufficient consciousness to experience dreaming.

Neural correlates denote dreaming

Tracking neural correlates of dreaming is another non-verbal way through which we could detect animal dreaming. When we dream, there is heightened activity in certain areas of the brain. Using this, we can detect when someone is dreaming. However, the study of neural correlates of dreaming goes beyond simply knowing someone is experiencing a dream, it can give us an idea of dream content. Activation of different areas of the brain coincides with dream content. For example, Siclari and colleagues (2017) found that a different area will be activated for facial recognition than for walking or running in a dream. These findings could have the potential for us to not only study animal dreaming but to determine the contents of animal dreams. However, the technology is not quite there yet, but I look forward to seeing future developments of this technology.

Evidence of new learning

One of the main functions of dreaming is the consolidation of newly acquired memories. A specific neural pattern will fire when forming a new memory, then will replay during sleep. This has not only been shown in humans but in rats as well. Dupret and colleagues (2010) placed rats into a new environment and measured the “place-related firing” of neurons. While the rats were asleep, they observed similar neuron firing. Rats that had this neural replay process disrupted had impaired memory of the environment, indicating that neural replay is essential in forming new memories.

However, dreams are rarely exact replays of memories our brains are consolidating. The memories get warped and woven into other dream content, so in observing replays we would not expect to see the exact neural pattern repeated, but a slightly altered one. Gupta and colleagues (2010) discovered this changing neural pattern in rats. They found that the neural pattern played not just forwards, but backwards as well. They also observed the pattern changing in novel ways, indicating active learning.

Though animals may not be able to discuss their dream lives with us, there are many promising ways to study animal dreaming. As we unravel the evolutionary drivers behind dreams, we may continue to discover different avenues for the non-verbal study of dreams. Given all the evidence just discussed, I am inclined to believe that when my pup’s busy paws mimic running in her sleep, she truly is chasing her dream squirrel, and maybe even catching it for once.

References

Gupta, A. S., Meer, M. A., Touretzky, D. S., & Redish, A. D. (2010). Hippocampal Replay Is Not a Simple Function of Experience. Neuron, 65(5), 695-705. doi:10.1016/j.neuron.2010.01.034

Jouvet, M. (1979). What does a cat dream about? Trends in Neurosciences, 2, 280-282. doi:10.1016/0166-2236(79)90110-3

LaBerge, S., Greenleaf, W., & Kedzierski, B. (1983). Physiological responses to dreamed sexual activity during lucid REM sleep. Psychophysiology, 20, 454-455.

Laberge, S. (1986). Lucid dreaming: Psychophysiological studies of consciousness during REM sleep. Sleep and Cognition., 109-126. doi:10.1037/10499-008

Malinowski, J., Scheel, D., & Mccloskey, M. (2021). Do animals dream? Consciousness and Cognition, 95. doi:10.1016/j.concog.2021.103214

Medeiros, S. L., Paiva, M. M., Lopes, P. H., Blanco, W., Lima, F. D., Oliveira, J. B., . . . Ribeiro, S. (2021). Cyclic alternation of quiet and active sleep states in the octopus. IScience, 24(4), 102223. doi:10.1016/j.isci.2021.102223

Medeiros, S. L., Paiva, M. M., Lopes, P. H., Blanco, W., Lima, F. D., Oliveira, J. B., . . . Ribeiro, S. (2021). Cyclic alternation of quiet and active sleep states in the octopus. IScience, 24(4), 102223. doi:10.1016/j.isci.2021.102223

Siclari, F., Baird, B., Perogamvros, L., Bernardi, G., Larocque, J. J., Riedner, B., . . . Tononi, G. (2017). The neural correlates of dreaming. Nature Neuroscience, 20(6), 872-878. doi:10.1038/nn.4545

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Does Your Child Have Nightmares?

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When should you be concerned, and what should you do?

All of us can clearly recall at least one heart-pounding, fear-inducing nightmare from childhood that startled us out of our sleep. Whether it was a chasing dragon or a precipitous fall from a great height, it felt so real it left us shaken long after awakening. However, as adults we know that there isn’t a monster under our beds waiting to snatch us, even if we just dreamt about one. For children, nightmares can be confusing because they feel so very real. And as young children, the line between fantasy and reality is blurred,

Nightmares are completely normal phenomena, especially for children. They usually begin between age 2-4 and tail off by age 10-12. They are a developmental process and are a normal response to fear. They can be triggered by stressful events like starting school, family illness or conflict. In fact, nightmares can actually help process emotional events.

However, despite their potential to be helpful, nightmares do cause considerable distress and can disrupt sleep. So how can you help your child if they have frequent and distressing dreams?

  1. OFFER COMFORT AND SAFETY

Give them a hug, let them know they’re safe, that they’re not alone. Their nervous system is in a charged state. They need soothing to restore a sense of safety in their bodies.

  1. DON’T DISMISS DREAMS

Don’t try to talk them out of their experience or dismiss their dream using logic. In an attempt to offer comfort, don’t say, “It was just a dream, it’s not real” and expect that to be the end of it. Children experience their dreams as very real, and for certain, the intense feelings nightmares stir up are tangibly experienced.

  1. NORMALIZE TALKING ABOUT DREAMS

Ask your child about their nightmares. If they feel okay telling you about it, listen to the story of their dream. Sharing it with you will help take away some of the charge. It gives them a way to talk about their fears. There may be pressures they are facing that you have no idea about. Growing up is fraught with uncertainty and challenges that may seem inconsequential from an adult perspective.

Some children rarely articulate what’s scary for them, so we don’t get a chance to dispel needless worries or offer help. But their nightmares can do the talking for them in the form of metaphors and expressions of their main concerns.

Keep tabs on your child’s dream life, especially if it seems unusually dark and disturbing. If you make talking about dreams a normal part of the routine, you’ll know how often your child has nightmares and how distressing they are. You’ll be in a good position to know if professional help is warranted. And you will have gathered useful information to convey to a therapist about your child’s sleep.

  1. WHEN TO CONSIDER PROFESSIONAL HELP

Nightmares are considered chronic if they happen every week or more for at least 6 months. Fully 5% of children between the ages of 3-10 experience chronic nightmares, and for many, this is a normal developmental process. However, if chronic nightmares persist past about age 10, they are more likely to continue into adolescence and beyond. Age 9-11 is a critical juncture, a time to consider treatment if your child continues to have frequent, distressing nightmares.

Fortunately, effective treatment is available.

Imagery Rehearsal Therapy, (IRT) has been found to be effective in numerous controlled clinical trials in adult populations (ie with veterans and rape victims). This evidence has also been extended to children in a number of smaller studies that have shown it to reduce nightmare frequency, distress and general anxiety in children. Results were sustained 6-9 months post-treatment.

Imagery Rehearsal Therapy (IRT) is the most highly-recommended approach to nightmare treatment for any age group. Other protocols, like Exposure, Relaxation and Rescripting (ERRT) appear to work as well, but have simply not been studied as much. IRT is a non-invasive, cognitive behavioural approach that simply asks the dreamer to imagine and rehearse a new dream ending. This seeds a new story that often weaves its way into future dreams. One study showed that some children using IRT spontaneously became lucid after treatment and were able to alter their nightmares from right inside the dream.

  1. TRY DREAM THERAPY AT HOME

The original protocol for IRT suggests changing the dream in any way you want. However, for children, I recommend asking them the shift the dream in ways that help them feel better about the dream, ideally ways that bring a sense of hope and mastery.

To try your own version of this approach, first help your child feel safe and calm. Then ask them to recall their nightmare briefly, perhaps just up to the place where they might want something about the dream to change. Then ask them what they imagine could happen next in the dream to make the dream better. For example, ask what form of help, escape route, magic or superpower they might want to use. Let them know it’s their dream, and they can change it it any way they like.

For example, suppose your child dreams there is an evil monster under the bed, lurking and waiting for a limb to dangle over the edge so it can grab an arm or leg and drag them under. You could ask your child to imagine going back into their dream, to the part before it got scary. They could change the dream so what’s now under the bed is a favorite toy, perhaps a cuddly teddy bear that comes to life and takes them off to play in the clouds.

Or they might dream of a fire-breathing dragon chasing them. Often, it can really help to turn and face the dragon or monster, to really see it and perhaps ask what it wants. I did this with my daughter, reminding her of how I often sang Puff the Magic Dragon to her at bedtime. Her dream dragon became like Puff — lonely and in need of a friend. When playing with how to rescript nightmare, encourage children to give their imagination free rein, offer suggestions and keep it positive.

After rescripting, a further step in IRT is to rehearse the new dream ending, something children may need to be reminded to do. You can do a number of things to reinforce the new dream imagery for a child. You might suggest they draw a picture of it, imagine it again during the day, and/or tell you about it again as you tuck them in at bedtime.

What happens when we reimagine our nightmares or help our kids to do so? Sometimes the new dream ending becomes incorporated into future dreams, making them less frightening. Other times, people report a new ability to change their dreams from within. And sometimes the nightmare just stops coming. If the process doesn’t work the first time, try again, and play with different dreams as they come up. Do seek professional help if chronic nightmares persist or the process itself is upsetting (this is extremely rare). With the right support, and in time, your child will have fewer, less distressing nightmares. They may even come to cherish their dreams.

 

Are you a parent concerned about the frequency and intensity of your child’s bad dreams? Should you be concerned?
Learn more about Nightmare Relief for Everyone designed by nightmare expert Dr. Leslie Ellis, this self-paced user-friendly and accessible online course covers the very latest in science and research about what nightmares are, and what they’re not. Leslie offers some simple steps you can take to get some relief from nightmares and other nocturnal disturbances – both for yourself and for others, including your children.

 

References

Fernandez, S., DeMarni Cromer, L., Borntrager, C., Swopes, R., Hanson, R. F., & Davis, J. L. (2013). A Case Series: Cognitive-Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children. Clinical Case Studies, 12(1), 39–59. https://doi.org/10.1177/1534650112462623

Mélanie St-Onge, Pierre Mercier & Joseph De Koninck (2009) Imagery Rehearsal Therapy for Frequent Nightmares in Children, Behavioral Sleep Medicine, 7:2, 81-98, DOI: 10.1080/15402000902762360

Schredl, M., Fricke-Oerkermann, L., Mitschke, A., Wiater, A., & Lehmkuhl, G. (2009). Factors affecting nightmares in children: parents’ vs. children’s ratings. European child & adolescent psychiatry, 18(1), 20–25. https://doi.org/10.1007/s00787-008-0697-5

Schredl, M., Fricke-Oerkermann, L., Mitschke, A. et al. Longitudinal Study of Nightmares in Children: Stability and Effect of Emotional Symptoms. Child Psychiatry Hum Dev 40, 439–449 (2009). https://doi.org/10.1007/s10578-009-0136-y

Simard, V., & Nielsen, T. (2009). Adaptation of imagery rehearsal therapy for nightmares in children: A brief report. Psychotherapy: Theory, Research, Practice, Training, 46(4), 492–497. https://doi.org/10.1037/a0017945

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Does Your Child Wake Up Screaming? How to understand and treat night terrors

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I used to dread going to bed when we lived in my lovely heritage apartment in Vancouver. Every night, about two hours after falling asleep, I would be startled awake by the most blood-curdling, agonizing screaming from the woman next door. Her window faced ours, and she sounded as though she was being murdered in her sleep almost every night. I wondered why no one would wake her up or help her. I have since learned that this would not have done much good as she was having night terrors.

So many people I’ve spoken with about this have suffered the same thing with their children. Night terrors are fairly common in very young children, affecting 20-40% of children under age 3, and 3-14% of school age children, but just 2% of adults (APA 2013). In a typical episode, parents will put their child quietly to bed only to hear them thrashing and screaming in terror about three hours later. The kids were hard to fully wake up, disoriented and confused, often with little or no memory of the incident in the morning.

Night terrors are often mistaken for nightmares. At a recent talk I gave about nightmares, most of the questions were actually about night terrors – from desperate parents wanting to know if there was something they could do about them. I treat nightmares, not night terrors, but I did some investigation, and there are a few things to know and to do that can help. First and foremost, know that they are generally benign and kids usually grow out of them.

Who Has Night Terrors?

Before I get into some of the ways you can help your child with their night terrors, it helps to understand what they are, who has them and why. A thorough survey of the literature suggests that although the exact cause is not well understood, genetic, developmental, environmental, psychological and organic factors can all play a part.

Night terrors most common in early childhood. A longitudinal study (Petit et al., 2015) of 1,940 children from Quebec found that 34% of children aged 18 months experience night terrors, 13% at age 5, and 5% at age 13. A recent review (Leung et al., 2020) found the peak may be later, at age 5-7 years. Either way, sleep terrors typically start at a very young age and stop at adolescence. It’s rare that the condition continues into adulthood – although for some it can switch to sleepwalking.

Sleep terrors are more common under a number of conditions that can be controlled, at least to some degree, such as: sleep deprivation, going to bed with a full bladder, emotional stress, anxiety (including separation anxiety), bullying, a noisy sleeping environment and excessive alcohol or caffeine. Other factors associated with this parasomnia include: febrile illness (unexplained fever), ADHD, autism, epilepsy, sleep apnea and PTSD. Some medications, especially those that are sedative, can lead to night terrors because they increase the duration of non-REM, the deep sleep stage in which these episodes occur.

It bears repeating the while night terrors are very distressing and can disrupt sleep for both children and their parents, they are not considered dangerous. They warrant clinical attention only if they are severe enough to disrupt daytime functioning. If you are considering consulting a doctor, keep a sleep diary and track BEARS. Not the big furry animal, but the 5-item assessment tool for children with sleep problems (Owens & Dalzell, 2005):

  • B: bedtime issues
  • E: excessive daytime sleepiness
  • A: night awakenings
  • R: regularity and duration of sleep
  • S: snoring

What Are Night Terrors?

In a typical episode, the child will sit bolt upright or even jump out of bed, heart racing, screaming in terror. They may speak, but what they say will be confused and incoherent because although they appear to be awake, they are in a hybrid sleep-wake state. They will be difficult to wake fully because these episodes occur during very deep (slow-wave) sleep. It’s best not to wake them up during an episode, and typically they won’t recall a thing in the morning.

Night terrors are distinguished from nightmares because they happen in the first half of the night associated with the deeper (stage 3 and 4) of non-REM sleep, while nightmares mainly occur in the second half, and are associated more with REM sleep and dreaming. Nightmares are clearly recalled in vivid detail, and those who have them tend not to thrash around and scream.

Night terrors are much more common in children. When they continue into adulthood, they look a bit different. While two-thirds of children have no recollection after episodes of night terrors or sleepwalking, the same proportion of adults do recall at least one experience and remember their episodes about half the time (Castelnovo, et al., 2021). For adults, night terrors appear to be more of a dissociative experience, and can be accompanied by hallucinations.

What you can do about night terrors

While none of the suggestions below work all the time, there are a number of things you can try to reduce or even eliminate night terrors. Excellent sleep hygiene (such as regular bedtimes; limiting screen time, no food and drink before bed, especially sugar and caffeine; dark, cool quiet bedroom; and wind-down rituals like story time) can all help reduce night terrors. Parents can also do their best to limit stresses on kids who have night terrors – things like bullying and separation anxiety might be addressed. Interestingly, psychological factors are found to be mostly associated with night terrors in teens and adults, but not children.

Wake-up treatment. One treatment that has met with some success is to wake a person up about half an hour before they would typically have an episode. If you do this for two weeks, it can break the cycle and stop it from recurring. In some cases, however, the episodes simply start occurring later in the night.

Co-sleeping. One interesting paper (Boyden, Pott & Starks, 2018) suggests that sleeping with your child stops night terrors, especially with very young children. The authors say that evolution did not design humans to sleep alone when very young and that “night terrors are the result of an environmental mismatch between evolved behaviour and the modern cultural practice of solitary sleeping.” This solution has not been empirically tested, but anecdotally, it appears to work for many.

The bottom line is that while night terrors can seem extreme, they are usually benign and your child will experience them less and less over time. There are a number of things you can try, such as good sleep hygiene, limiting stress, waking them prior to an episode and co-sleeping. To all those exhausted parents reading this, I hope it has been of some help.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Davey, M. (2009). Kids that go bump in the night. Australian Family Physician, 30, 290- 294.

Ekambaram, V., & Maski, K. (2017). Non- rapid eye movement arousal parasomnias in children. Pediatric Annals, 46, e327-e331. doi:10.3928/19382359-20170814-01

Golbin, A.Z., Guseva, V.E., & Shepovalnikov, A.N. (2013). Unusual behaviors in sleep as “compensatory” reactions aimed at normalizing the sleep–wake cycle. Human Physiology, 39, 635-641. doi:10.1134/ S0362119713060042

Ivanenko, A., & Johnson, K.P. (2016). Sleep disorders. In M.K. Dulcan (Ed.), Dulcan’s textbook of child and adolescent psychiatry (2nd ed.). Arlington, VA: American Psychiatric Publishing.

Laberge, L., Tremblay, R.E., Vitaro, F., & Montplaisir, J. (2000). Development of parasomnias from childhood to early adoles- cence. Pediatrics, 106, 67-74. doi:10.1542/ peds.106.1.67

Leung, A. K. C., Leung, A. A. M., Wong, A. H. C., & Lun Hon, K. (2020). Sleep terrors: an updated review. Current Pediatric Reviews, 16(3), 176-182.

Murphy, P.J., Frei, M.G., & Papolos, D. (2014). Alterations in skin temperature and sleep in the fear of harm phenotype of pediatric bi- polar disorder. Journal of Clinical Medicine, 3, 959-971. doi:10.3390/jcm3030959

Nguyen, B.H., Pérusse, D., Paquet, J., Petit, D., Boivin, M., Tremblay, R.E., & Montplaisir, J. (2008). Sleep terrors in children: A prospective study of twins. Pediatrics, 122, e1164- e1167. doi:10.1542/peds.2008-1303

Petit, D., Pennestri, M.H., Paquet, J., Desautels, A., Zadra, A., Vitaro, F.,…Montplaisir, J. (2015). Childhood sleepwalking and sleep terrors: A longitudinal study of prevalence and familial aggregation. JAMA Pediatrics, 169, 653-658. doi:10.1001/ jamapediatrics.2015.127

Salazar, F., Baird, G., Chandler, S., Tseng, E., O’Sullivan, T., Howlin, P.,…Simonoff, E. (2015). Co-occurring psychiatric disorders in preschool and elementary school-aged chil- dren with autism spectrum disorder. Journal of Autism and Developmental Disorder, 45, 2283- 2294. doi:10.1007/s10803-015-2361-5

Silvestri, R., Gagliano, A., Aricò, I., Calarese, T., Cedro, C., Bruni, O.,…Bramanti, P. (2009). Sleep disorders in children with attention- deficit/hyperactivity disorder (ADHD) re- corded overnight by video-polysomnography. Sleep Medicine, 10, 1132-1138. doi:10.1016/ j.sleep.2009.04.003

Wolke, D., & Lereya, S.T. (2014). Bullying and parasomnias: A longitudinal cohort study. Pediatrics, 134, e1040-e1048. doi:10.1542/ peds.2014-1295

Are you a parent concerned about the frequency and intensity of your child’s bad dreams? Should you be concerned?
Learn more about Nightmare Relief for Everyone designed by nightmare expert Dr. Leslie Ellis, this self-paced user-friendly and accessible online course covers the very latest in science and research about what nightmares are, and what they’re not. Leslie offers some simple steps you can take to get some relief from nightmares and other nocturnal disturbances – both for yourself and for others, including your children.

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Dream Changes During the Pandemic Reflect Massive Collective Trauma

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A multinational study concludes that dreams are a reflection of massive collective trauma, and that dreams and dream recall must be integrated into approaches for improving mental health and health in general.

By Dr. Leslie Ellis

Since the beginning of the COVID-19 pandemic, the world has collectively been dreaming more, and our dreams have reflected the rise in stress levels, fear and uncertainty. A group of 23 researchers from 14 countries teamed up to take an in-depth look at how the pandemic has affected our dream recall and how this impacts health and mental health. They conclude that dreams are “an often-forgotten expression of the existential situation of individuals” and that they need to be integrated into how we understand and support mental health.

A recent multinational study of more than 19,000 adults explored the associations between dream recall frequency and related social, health and mental health factors, comparing data prior to and during the pandemic across four continents and 14 countries. Higher dream recall was linked with nightmares, sleep talking, recurrent disturbing thoughts and PTSD symptoms. As in previous studies, this one showed that women have been affected more than men, but also that those aged 55-64 had lower dream recall than younger people.

While the higher intensity of emotion during the pandemic has generated more dream recall — associated with more PTSD symptoms, problems with sleep maintenance, more nightmares and parasomnias — there is one interesting finding that bears further inquiry. Contrary to earlier studies, in the one, high dream recall was negatively associated with depression and anxiety. This could be because dreaming can help regulate the strong emotions people are experiencing in these turbulent times. However, the authors speculate that it could also be the result of the dream-dampening effect of anti-depressant medication. They said not enough specific data was collected to solve this riddle.

The study’s authors wrote: “The COVID-19 crisis has touched every person in the world in some way, whether it is related to becoming infected, suffering financially, through reduced social contacts, missed opportunities, or an inability to get required supplies and materials. It has become a communal trauma that has a profound impact on people around the world. One of the most difficult aspects of the pandemic is social isolation and confinement. Solitude goes against our inborn social instincts to form and maintain relationships as human beings and live in herd- or swarm-like alignments. Recent research has shown that the pandemic has led to increased anxiety levels, panic attacks, irrational fears, post-traumatic stress, depression, fatigue, reduced sleep quality, and sleep disturbances. Given the effects it has had on our everyday lives, perhaps it is unsurprising that COVID-19 has crept into our dreams.”

Earlier, smaller studies in various parts of the world (China, Italy, USA) have corroborated the findings that our dreams have been more intense and frequent during the pandemic, and that there are differences in how men and women have been dreaming. For example, a US study found that women with higher education were affected more than others, and several Italian studies showed that while all of us have experienced an increase in dream recall, women have been more affected.

“Since the pandemic has reportedly led to worsened mental health and higher levels of depression, anxiety, distress and symptoms of PTSD, heightened dream recall frequency might be an expression of the current mental health status,” according to the study authors. Women may be more affected as they have had to face more of the load – including increased childcare and health care responsibilities and greater job losses.

In their concluding comments, the authors called for more attention to dreams in mental health care and in general. “Dreams and dream activity are an often-forgotten expression of the existential situation of individuals. Based on our results, we assume that disruption in sleep patterns due to changes caused by the pandemic explains the increase in dream recall. Additionally, we propose that the observed increased dream recall frequency in our sample is an expression of the emotional intense and demanding experience of the current situation and could be an indicator that the pandemic is indeed turning into a collective trauma… Therefore, dreams and dream recall deserve more attention as potential support for coping with crisis situations, such as the COVID-19 pandemic and overall in supporting psychological wellbeing. Dreams and dream recall need to be accepted more and integrated into approaches for improving mental health and health in general.”

 

If you are a mental health professional interested in learning more about nightmares, parasomnias, and their treatment, sign up for my short, focused online course. Because I feel this material is important to disseminate, the course is always open, is self-paced, and discounted during the pandemic. Please ask your clients if they have nightmares, and let them know they are treatable.

 

Check out the Short Focused Course on Nightmare Treatment using THIS LINK. 

References

Fränkl E, Scarpelli S, Nadorff MR, Bjorvatn B, Bolstad CJ, Chan NY, Chung F, Dauvilliers Y, Espie CA, Inoue Y, Leger D, Macêdo T, Matsui K, Merikanto I, Morin CM, Mota-Rolim S, Partinen M, Penzel T, Plazzi G, Sieminski M, Wing YK, De Gennaro L, Holzinger B. How our Dreams Changed During the COVID-19 Pandemic: Effects and Correlates of Dream Recall Frequency – a Multinational Study on 19,355 Adults. Nat Sci Sleep. 2021;13:1573-1591
https://doi.org/10.2147/NSS.S324142

Iorio I, Sommantico M, Parrello S. Dreaming in the time of COVID-19: a quali-quantitative Italian study. Dreaming. 2020;30(3):199–215. doi:10.1037/drm0000142

Nielsen T. Infectious dreams. How the COVID-19 pandemic is changing our sleeping lives. Sci Am. 2020;323:31–35.

Pesonen A-K, Lipsanen J, Halonen R, et al. Pandemic dreams: network analysis of dream content during the COVID-19 lockdown. Front Psychol. 2020;11:2569. doi:10.3389/fpsyg.2020.573961

Scarpelli S, Alfonsi V, Mangiaruga A, et al. Pandemic nightmares: effects on dream activity of the COVID-19 lockdown in Italy. J Sleep Res. 2021;e13300. doi:10.1111/jsr.13300

Schredl M, Bulkeley K. Dreaming and the COVID-19 pandemic: a survey in a U.S. sample. Dreaming. 2020;30(3):189–198. doi:10.1037/drm0000146