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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.

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Active Imagination: How and Why

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For Those Who Don’t Dream, Invite Waking Dreams

If you are someone who doesn’t recall many dreams, and yet would like to engage with your dream life more deeply, there are a couple of solutions. I typically offer tips for improving dream recall but another option is to cultivate waking dreams. If you are persistent with this practice, you could even start your own ‘Red Book’ by crafting a record of your inner process.

I recently hosted a webinar on Active Imagination. I began by leading participants in an imaginal journey designed to create a rich, experiential and dream-like sequences. (A recording is available if you missed it.) I asked for a few to share their experiences and what emerged were surprising, helpful and deeply-moving scenarios, as evocative as any dream. (This imaginative process is also great for those who do recall dreams and want to engage further with them.)

Jung himself said that the products of active imagination are identical to dreams: “Image and meaning are identical; and as the first takes shape, so the latter becomes clear.” (Jung on Active Imagination, 1977.)

 

Jung on How To Cultivate Active Imagination

Those who don’t recall dreams may also find it hard to allow imagination to flow. This comes with practice and by making the most of the initial wisps of image that arrive in your mind’s eye, fleshing them out and inquiring into them. You could try Jung’s advice from his “Letters to Mr. O” about how use any image as a leaping-off place for your imagination, whether it be from a dream, memory or fantasy:

“Start with any image, for instance just with that yellow mass in your dream. Contemplate it and carefully observe how the picture begins to unfold or to change. Don’t try to make it into something, just do nothing but observe what its spontaneous changes are… note all these changes and eventually step into the picture yourself, and if it is a speaking figure, then say what you have to say to that figure and listen to what he or she has to say.”

As you let the dream image flow forward, don’t worry if it feels like you’re making it up – that’s what imagination is! Just do your best to give the image its autonomy. You will know you’re on the right track when what emerges surprises you.

 

Imaginal Dialogue as a Writing Exercise

Another great way to have a conversation with an image is by writing from both sides of the conversation. This way you also have a written record of it that you can reflect upon further. I treat it a bit like writing a poem – I find if I write a line, the next one tends to arrive on its own if I am patient and open enough.

In the Imaginal Dialogue practice, prepare by settling in your mind and body, create a sense of calm and safety that you can return to if needed. Write your name, a colon and then an opening greeting to your image. On the next line, write the name or descriptor of the character you want to engage with, then visualize the dream image in detail and wait for it to respond. You may see them speaking in your mind’s eye, hear a voice in your head, or just ‘know’ what the image says.

Here is an example using a classic intruder nightmare:

Dreamer: Can I ask you some questions?

Bandit: Make it quick, I’m in a hurry, and I don’t want to get caught here.

Dreamer: But you’re breaking into my house! What are you looking for?

Bandit: I’ve lost my family, lost my mind, trying to find a way home…

Dreamer: Do you think you will find it in my house?

Bandit: There was a warm glow from the window, I could hear laughter….

 

It’s not unusual for a threatening dream figure to open up and soften as was beginning to happen in this example. It can be a way to befriend an apparently hostile dream character. However, the process is hard to predict, so I always recommend starting with a calm mind and body and a sense of positive intention. Let the dialogue flow to a natural stopping place. Pick it up again if desired.

Jung had long, ongoing conversations with his imaginal figures, artfully recorded in his now-famous Red Book. He suggested his patients make their own version, capturing their inner life in words and images with care and beauty.  A patient of his recalled Jung saying such a book “will be your church, your cathedral – the silent places of your spirit where you will find renewal.”

 

Does This Process Have a Purpose?

A woman in the webinar asked me if we have a goal in mind as we engage with active imagination. I said no, it’s best to leave the end-game open and let the implicit unfold without directing it. Having a goal presumes the destination before we let our inner life speak. Our imaginal characters may have an alternative set of priorities that could be woven into our own in a way that changes our trajectory. The process creates shifts, but not the logical or predictable ones associated with goal-setting.

If not a goal, then, Active Imagination can have a purpose, one that has the potential to connect us with our own greater purpose. The images that come in contemplative moments speak to us across time and drop us deep. This can be an antidote to the barrage of instant messaging and 60-second sound bites that prevail in modern media, distracting us from our depths.

Jung told his patient not to listen to anyone critical of her personal red book project: “If you listen to them, you will lose your soul – for in that book is your soul.”

 

For more about how to work with active imagination, the full 90-minute webinar is available here. This is the third in three-part series that include finding help in a dream, and embodying dream elements. Recordings are available for all 3 sessions for a nominal fee.

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Befriending the old hag: A primer on sleep paralysis

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Folklore, causes and approaches to treatment and prevention

In Newfoundland, they tell stories of her: a terrifying creature said to live in the ocean and torment those who dare to sleep near the shore. In a typical account, a fisherman returns home exhausted from a long day at sea, lays down to rest and starts to drift off to sleep. But as he does so, he feels a heavy weight and can’t move or speak. Sitting heavily on his chest, is the dreaded Sea Hag, a wild woman with ragged clothes, straggly hair and long, sharp nails. She returns night after night until he arms himself with a crucifix and gathers the strength to command her to leave him be, in the name of God.

Tales of the Sea Hag are legendary in Newfoundland, one of the stories now told on the St. John’s Haunted Hike tour. The legend of the Sea Hag emerged as a way to make sense of sleep paralysis, a temporary inability to move or speak during the sleep-wake transition. As legend had it, the only way to defeat the Sea Hag was by invoking the name of God.

The history and folklore surrounding sleep paralysis can be traced back to ancient civilizations, and not understanding it, many cultures attributed it to supernatural forces. The Sea Hag is a variant of the “old hag” dating back to medieval Europe, a demonic entity that would sit on a person’s chest, a way to explain the pressure and immobility of sleep paralysis.

 

What causes sleep paralysis?

An episode can occur while falling asleep (hypnagogia) or in the transition from sleep to waking (hypnopompia). Symptoms include an inability to move, often accompanied by pressure on the chest or back, hallucinations and the sense of doom or an evil presence. Sleep paralysis often occurs during sleep cycle disruptions (ie from shift work, jet lag, insomnia), but can also coincide with mental health issues. This fairly common, mostly benign condition affects about 8% of the general population at some point in their lives.

During REM sleep, to protect us from thrashing around and enacting our dreams, our body goes into a state of muscle atonia. The exact mechanism, which inhibits the motor neurons in the spinal cord, is not fully understood. It is thought to involve a combination of factors, including changes in brain chemistry and activation of inhibitory neurons.

The body naturally shifts out of paralysis upon waking, and external stimuli such as touching or speaking to the person can trigger the shift as well. In sleep paralysis, the shift to the natural ability to move simply happens in the wrong order; we are supposed to wake up after our movement is restored to normal, not before.

 

How to treat sleep paralysis

Lauren was plagued with nightmares as a child, and as she grew older this shifted to frequent, terrifying sleep paralysis. She tried some of the most common ways to treat the problem, including changing her sleeping position, taking melatonin, practicing good sleep hygiene. What finally helped most was to turn toward the experience and relax into it rather than resisting and struggling to move. She reminded herself that she was not in any danger, and that she could still breathe – so she focused on slow, relaxing breaths, and the calmer she got, the less intense the sensations became. Over a few weeks of practicing relaxing into the transition to sleep, she was able to break the cycle.

The way to treat sleep paralysis depends on what may be causing it. While sleep paralysis can affect anyone, those with psychiatric disorders, a history of trauma, sleep disorders and disrupted sleep patterns are more likely to experience it. Therefore, effectively treating trauma, anxiety and/or depression may help those with psychological causes.

Disrupted sleep can come from shift work, sleep apnea, or too much late-night partying. This is why sleep paralysis is not uncommon among post-secondary students who stay up way too late studying or socializing. Sleep apnea also causes disrupted sleep, and sometimes sleep paralysis.

Overall, what helps:

  • practice good sleep hygiene, a regular bedtime and ideally a cool, dark quiet bedroom
  • sleep on your stomach or side, not your back
  • reduce stress
  • medication, such as melatonin or antidepressants
  • treat underlying causes: ie therapy for a history of trauma, anxiety or depression, sleep medicine for apnea

 

What to do during an episode

Sometimes, despite one’s best efforts, sleep paralysis will occur. If this happens, following Lauren’s example of relaxing into the process can make a real difference. Once you understand what’s happening, you can tell yourself, it’s okay, I am safe in my bedroom and still in the dream state. If you want to wake up calmly, focus on slow, deep breaths and begin to wiggle your fingers and toes, waiting until the paralysis dissipates. Although it may feel like an eternity, the transition is usually just a minute or two.

If you want to go back to into sleep rather than waking, you might try lucid dreaming. In fact, during an episode, you are in a lucid dream – as defined by being both awake and in a dream state. You might want to experiment with relaxing back into sleep and creating a dream scenario that feels empowering rather than scary. You might imagine into flying away from the source of your fear and into a beautiful landscape. Or you could conjure the presence of an ally or friend.

To give one example, Marian tried many things to alleviate her sleep paralysis before turning to lucid dreaming. She was desperate at this point, and decided to set an intention before sleeping that if she experienced paralysis, she would recognize she was dreaming. It took a few weeks, but after an initial exhilarating experience of flying in her dream, she got more adept at becoming lucid. This coincided with a shift toward better, more refreshing sleep and a whole new relationship to her dreams.

#sleepparalysis #oldhag #seahag #sleepdisorders #nightmares #sleephealth #sleephygiene #sleepmedicine #sleeptherapy #mentalhealthawareness #stressrelief #mindfulness #luciddreaming #sleepresearch #sleepscience

 

In my complete course on nightmares for clinicians, I offer much more information about the origins, theories and treatment of nightmares. Click here to learn more.

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New study shows altered nervous system activity for those with frequent nightmares

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New study shows altered nervous system activity for those with frequent nightmares

In a recent paper on nightmares and the autonomic nervous system (ANS), I described how polyvagal theory might inform clinicians seeking to understand and treat those with frequent nightmares (Ellis, 2022). A new paper, desceribed below, offers further evidence that nightmares are implicated in alterations in the ANS.

 

A free talk on how to apply polyvagal theory to nightmares

For those interested in applying these ideas in clinical practice, consider joining me for the upcoming free presentation Nightmares: How Polyvagal Theory Informs Treatment. I am a guest of Jan Winhall’s free felt-sense polyvagal approach to trauma group hosted by the Polyvagal Institute on April 21.

 

Recent research corroborates the nightmare-ANS link

Tomacsek and colleages (2023) studied a group of 24 frequent nightmare sufferers and 30 control participants, examining heart rate and heart rate variability (HRV) at various sleep stages and in response to emotion-inducing pictures. Increased heart rate and reduced HRV indicate nervous system dysregulation, and are increasingly used as measures in emotion and sleep research (specifically to measure parasympathetic dysregulation).

 

The researchers found a significant difference in the heart rate of nightmare sufferers versus controls but only during the sleep portion of the study “suggesting autonomic dysregulation, specifically during sleep in nightmares.” The researchers also found reduced HRV in the nightmare group during the picture-viewing task, which was intended to create a nightmare-like experience during waking.

 

Dysregulation across sleeping and waking in severe cases

The researchers concluded that the extent of dysregulation during both sleeping and waking may depend on the intensity of disturbed dreaming. The participants in the study were frequent nightmare sufferers, but on the less severe end of the spectrum, with non-traumatic nightmares and no symptoms of posttraumatic stress disorder. Still, they found “trait-like autonomic changes during sleep and state-like autonomic responses to emotion-invoking pictures” and concluded that this indicates parasympathetic dysregulation is present in those who suffer from frequent nightmares. They suggested that ANS dysregulation would likely be more consistent across sleep and waking states in more severe cases.

 

As evidence such is this continues to corroborate a link between ANS dysregulation and nightmares, it will ideally lead to treatment protocols that take this information into account. One of the main tenets that polyvagal theory has brought to trauma treatment in general is the notion that attention to a felt sense of safety and to creating conditions that regulate the nervous system is essential to trauma recovery. My paper offers an articulation of ways to extend this polyvagal-informed approach to trauma treatment. Ideally, specific methods of instilling safety and ANS regulation would be considered an integral part of the treatment of nightmares.

 

Ellis LA (2022) Solving the nightmare mystery: the autonomic nervous system as missing link in the aetiology and treatment of nightmares. Dreaming. https://doi.org/10.1037/drm0000224

Tomacsek, V., Blaskovich, B., Király, A. et al. Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01573-2

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Dream engineers work on promising ways to improve nightmare treatment

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A group of dream researchers I met with this past month are focused on using technology and engineering to tackle big questions about dreams. February’s session was focused on improving treatment for nightmares. Consistent themes were: adding sensory triggers during dreaming to augment existing treatments; and the clear need for effective nightmare treatments to be implemented more widely.

 

Presenter Westley Youngren noted that current methods have variable effectiveness. The main nightmare prescription medication, Prasozin, did no better than placebo in a recent study. Imagery rescripting methods, the main psychptherapeutic intervention, have also shown varying levels of efficacy. “There’s room for improvement, so there’s room to take new and cutting edge science coming from the sleep and dreaming world and use this to improve upon current treatment options,” said Youngren.

 

As a starting point, Youngren is studying dream efficacy – which is the ability to have an impact on the content of your dreams. In particular, he is interested in how various dream intervention devices that you wear to track and send signals during sleep, can impact dream efficacy. Ultimately this information can lead to developing the best approach to change the course of nightmares from right inside the dream.

 

The Dream Engineering series is led by Dr. Michelle Carr, recently appointed assistant research professor at the University of Montreal and the Center for Advanced Research in Sleep Medicine. She plans to continue building this enthusiastic collaborative group focused on dream engineering. Her research interests are in dream function, how dreams impact waking life, and how these functions can be disrupted by nightmares. For example, she has researched ‘targeted lucidity’ using light and sound cues to trigger waking dream awareness, which can be used to treat nightmares.

 

Suicide researcher Dr. Michael Nadorff spoke about the alarming link between nightmares and suicide. He quoted an important study by Sjostrom and colleagues (2009) that found a 400% increase in suicide risk for those with frequent nightmares. The study followed 165 inpatients hospitalized for suicide attempt for two years, and found that persistent nightmare predicted suicide even after controlling for depression, anxiety, posttraumatic stress disorder and substance use. Nadorff’s own research supports this finding of nightmares as a independent risk factor for suicide, and he suggests more can be done about this:

 

“Time and time again in the literature, we’re seeing something unique about nightmares and suicide. We know that the strongest predictor of suicide is a past suicide attempt. So we did a study that looked at individuals who had one attempt in the past versus multiple suicide attempts to see what factors differentiate those groups. What was interesting is a lot of the main risk factors you know of did not significantly predict multiple attempts: not depression, anxiety or PTSD. Nightmares were the only factor in our study that actually differentiated repeat risk, and it was both current symptoms and chronicity independently. There’s something about having nightmares that puts you at greater risk of future suicide attempts. So there’s tremendous clinical need for these interventions.”

 

Lampros Perogamvros presented his research into using targeted memory activation (TMR) to increase the effectiveness of imagery rehearsal therapy (IRT) for nightmares. During the ‘rescripting’ phase of IRT, the new dream ending was paired with the sound of a piano chord, and this same sound was played during REM sleep. Of the 36 participants, half received the TMR/sound treatment. All participants reported fewer nightmares, but those who used the sound protocol had more positive dreams as well as significantly fewer nightmares than the control group. The mechanism did not seem to reduce fear within the dreams, but rather, to increase dreams with a positive valence. This unexpected result nevertheless shows that there are effective ways to augment existing nightmare therapies. There will surely be more to come from this engaged group of dream engineers.

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Experiential Dreamwork: Adding depth, creativity and transformation of trauma memory for you and your clients

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Over time, dreams appear to help take the emotional charge out of challenging memories while enabling us to retain the information we need to make more adaptive decisions in the future. Engaging with dreams can augment and strengthen this process.

By Dr. Leslie Ellis

Paying attention to dreams adds richness, creativity and depth to inner process. Bringing experiential dreamwork into clinical practice also increases the likelihood that clients will experience deep and lasting change. In my recently-published book, A Clinician’s Guide to Dream Therapy (Routledge, 2020), I offer many reasons for therapists to engage in dreamwork, both for themselves, and with clients. I close the book with a chapter on how neuroscience and dreamwork can combine to bring about transformation of core emotional patterns and beliefs. In this article, I offer a summary of these highlights from my book.

 

Why work with dreams?

“Clinicians who do not pay attention to their clients’ dreams are missing an opportunity to add a compelling dimension of depth, meaning and emotional authenticity to the therapy process. Because dreams often speak the language of metaphor, even the most seemingly-mundane content may carry important meaning that is outside of the dreamer’s immediate awareness. For example, a client who regularly brings dreams to therapy told me in one session that she had lots of dreams the previous night, but nothing important. Her dogs were in the dream, doing what they always do: the younger one pestering the older one who was, in the dream, getting to the point where she simply couldn’t take it anymore and was ready to snap. While acknowledging the dream snippet was literally true, the simple query: “Is there anything in your life like that, anything that you are completely fed up with?” opened up a whole avenue of process for her that was aptly represented by the dogs and may well have been left unexplored had she not mentioned her dream.

 

In addition to turning our attention to deeper matters, the benefits of working with dreams in clinical practice include the fact that dreams are creative and engage clients in the therapy process. They point to our most salient emotional concerns. They bypass our internal editing process and normal defenses, and so are unflinchingly honest representations of our life situation. Dreams can bring a new and wider perspective on a situation that seems otherwise stuck. They provide diagnostic information and can be indicators of clinical progress. They help to regulate our emotions, and working directly with the feelings dreams engender may strengthen this positive effect. They can be a safe pathway to working with trauma. The ‘big’ dreams we occasionally experience can literally change our lives, and dream therapy can facilitate and integrate this transformation.

 

Much of what we know about how clinicians use dreams in their practice is captured in a handful of studies that were reviewed by Pesant and Zadra (2004) with the goal of making clinicians aware that integrating dream work into their practice is both beneficial and accessible. The researchers found that while most therapists do work with dreams at least occasionally in their practice, the majority are not comfortable doing so because they feel they lack expertise or the necessary specialized training. In fact, it is most often the clients, not the therapists, who initiate dream work. The review also found evidence that dream work helps increase clients’ self-knowledge and insight, and increases their commitment to therapy, which can be a predictor of good therapy outcomes” (from chapter 1, A Clinician’s Guide to Dream Therapy).

 

Dreamwork informed by neuroscience can lead to transformation

We will now skip ahead to the final chapter which brings much of the preceding information together. I map a process that touches on how dreams are implicated in the updating of our emotional memories. The following is an abbreviated version of the last chapter: Transformation: Applying neuroscience to dreamwork.

 

“It used to be thought that emotional memories were not malleable, but the discovery of the processes behind emotional memory reconsolidation (Lane et al., 2015) has changed this view. Current evidence suggests the brain is more resilient and capable of changing and healing than previously thought, even later in life. This is a cause for optimism because now that we know something about the specific mechanisms of change, we can attempt to engineer our therapy processes to engender such changes. The beauty of this kind of change, which can take place in basic neural structures (at the synaptic level), is that once it has taken root, the test of success is that clients maintain the changed behavior automatically and without effort. This is not the white-knuckling kind of change that reverts back to its former patterns under stress.

 

Implicit emotional patterns are malleable, and can permanently transform into more up-to-date responses, but only under the right circumstances. It used to be thought that long-term emotional memory was indelible because it was stored in synapses, in the basic structures of the brain. But Lee and colleagues (2004) have shown that if certain conditions are met, the synapses will destabilize, making revision of fear memory possible without reinforcing the original memory. According to Ecker, Ticic and Hulley (2012), the keys to unlocking the emotional brain involve clear, repeatable steps that involve juxtaposing a deeply-felt experience of an outdated emotional belief with something that feels true in current life, but opposite. This creates instability in the memory, and if the new experience is reinforced in a timely way, it will not just cover over or compete with the old information, but will actually replace it. Ecker and colleagues state that the resulting change will be transformational, rather than incremental. In my experience, this can be the case, but when beliefs arose in different contexts, transformation may take place over time, with repetitive experience of how the new experience contradicts the older paradigm.

 

Do not treat the trauma itself, but the beliefs that arise from it

This research highlights something important to keep in mind when working with trauma. The traumatic events themselves are not the important focus. The process, and an open curiosity should be directed to the beliefs that arose out of the traumatic events with the understanding that fear generalizes. For example, people who suffered from chronic neglect in childhood often develop the belief that no one is ever there for them. Feeling deeply into the experience of having even one person consistently show up for them has the potential to shift this long-standing emotional pattern. This is why falling in love can be transformational. Implicit emotional beliefs are not generic, however, but quite specific. They must be experienced in the body rather than speculated about with the mind for the change process to initiate.

 

Such beliefs and their opposites are often referred to in dreams. Jung was the first to notice this pattern. He found it so pervasive that he developed his theory of dreams as compensation around this idea. Although many early theories about dreams have been successfully challenged, this one persists and is incorporated into many current theories that suggest dreams bring new information and have the potential to transform our long-held emotional beliefs based on current experience. Therefore, dream material can be a rich source of experiential information to use as a base for facilitating memory reconsolidation.

 

Doing what dreams do, only better

This section describes how we can take a dream and by focusing on it, assist in the very processes that dreams are implicated in – those of emotional memory reconsolidation and emotional regulation. Over time, dreams appear to help take the emotional charge out of challenging memories while enabling us to retain the information we need to make more adaptive decisions in the future. Dreamwork can augment and strengthen this process. And it can kick-start a ‘failed’ dreaming process that is not working as it should, as is the case with recurrent nightmares of those suffering from posttraumatic stress disorder (PTSD).

 

One of the challenges of trying to engender emotional memory reconsolidation is that it can take quite a bit of detective work to uncover an outdated emotional belief that was formed implicitly. Ideas about the nature of the world are often formed in childhood based on experiences from one’s family of origin, and early beliefs are rarely explicit or called into question. Having no other frame of reference as very young children, we see our environment as simply how the world works, and the beliefs we pick up are a way of adapting to the emotional and relational world we found ourselves in. Dreams, however, can bring our emotional beliefs to life as metaphorical images we experience directly. They often represent novel information that contradicts what we believe. Such images are the keys that can unlock the process of emotional memory reconsolidation, updating and transforming how we respond to life situations in light of current experience.

 

Those who consistently work with dreams as part of their practice of psychotherapy already have an intuitive understanding of how to work with dreams to bring about therapeutic change. Most invite their clients into a deeply experiential sense of the dream, a critical ingredient in the process. Dreams often have within them contrary elements that can be juxtaposed. Inviting the dreamer to deliberately hold this ‘tension of the opposites’ (Jung) can bring about deep and durable emotional shifts.

 

In my book’s final chapter, I am suggesting that armed with a basic understanding of the role of dreaming in emotional memory consolidation, we may be able to explore the dreams that clients bring to therapy in a way that facilitates or strengthens the helpful processes that dreams are already a part of. Well-considered current theories suggest that: dreams are implicated in the process of reducing the emotional charge of memories that have current relevance; and dreams play a part in updating our store of memories to include current experience, better preparing us for what’s next. This could also serve as a definition of what happens in psychotherapy. Not just the dreams themselves, but the dreamwork process within therapy can facilitate these emotional and memory updating processes. In addition, nightmare treatment research has shown that by using what we know about dreams in specific and thoughtful ways, we can repair sleep-dream-memory processes that are not working well, helping healthy dreaming to resume.

Clinical examples of transformational dreamwork

What I have noticed about the process of memory reconsolidation is that theories of psychotherapy incorporated its basic elements well before the neuroscience underlying the process was discovered. The trend in dreamwork toward greater experiential practices is an example of how therapists intuit and/or learn by experience to use methods that engender change. In addition, Jung’s notion that dreams are compensatory, and Gendlin’s bias control are two ways dreamwork brings about an experiential juxtaposition that can cause significant shifts in the dreamer’s store of emotional memory.

 

An example of memory reconsolidation at work is shown in the dreamwork with the Grateful Dead dream earlier in this book. Initially, the dreamer is terrified of being shot by ‘Jack’, the man who in waking life had been abusive and was now aware of where the dreamer worked. In the dreamwork, this fear was juxtaposed by the feelings of safety I encouraged her to sink into very deeply. There were at least two safe places in the dream to draw from: memories of her first love, and also being with a group of like-minded people on the bus who prevent Jack from harming her. In a later part of the session, I ask the dreamer to ‘be’ Jack for a minute, another form of juxtaposition; she feels how hollow and sick he is, before we move on to the part of the dream where she is safe on the bus.

 

There is a palpable release of tension in the course of working with the dream, and this is sustained, which is the hallmark of a successful memory reconsolidation process. The dreamer reported that prior to the dreamwork, she felt very anxious in general, and especially going to work. After the dreamwork, the fear was no longer present. She said, “I’m not holding the charge anymore.” She could walk into work without her usual worried pausing at the threshold, and this was not a conscious, but an effortless, automatic action reflective of a structural change in the nature of her fear memories. Interestingly, in her subsequent dream, she confronts Jack and he apologizes, which is further evidence of change. I believe such dream changes are significant and authentic reflections of clinical change because they happen without conscious volition.  The dreamwork also shifted the way the dreamer holds the memories about Jack, with more of a focus on her friends coming to her rescue and her desire to cultivate community in her life.

 

The ‘new was’

In the preceding example, the client arrives at a new vantage point. From there, she views the past differently, but also, paradoxically, with a sense that it has always been that way.  Gendlin (1984), called this the “new was.” He viewed feelings, thinking, actions and words all primarily as lived experience in the body, and each bodily event as implying what comes next. He called this ‘carrying forward’ and said, “In therapy we change not into something else, but into more truly ourselves. Therapeutic change is into what that person really ‘was’ all along… it is a second past, read retroactively from now. It is a new ‘was’ made from now.”  From this new was, steps come that change one’s conception of the past entirely. The change is not just a current one, but a shift that ripples through our entire store of memory, revising many things accordingly.

 

There is room here to think about state-dependent memory, something I encounter frequently in working as a psychotherapist. To play with the above example, when the client feels afraid, the memories of Jack feel much more ominous and she recalls the worst ones. When she is less afraid, she may recall better times, such as her earlier relationship with her first love.  This fear bias colors her perception of the world in general, and of relationships specifically. I believe that the elements of this dream were particularly salient and powerful tools for engendering lasting change in her sense of relational safety. It can be a challenge in psychotherapy to create deeply-felt juxtapositions necessary to revise emotional memory, but dreams provide ready-made and highly relevant material for this powerful transformation process.

 

 

Dr. Leslie Ellis is an author, teacher, researcher and therapist with an abiding interest in inner life. She teaches therapists how to work with embodied experience, trauma and dreams, and offers on-line courses in dreamwork and focusing. She has a PhD in Clinical Psychology with a somatic specialization. Shen has conducted award-winning research in treating nightmares of refugees using embodied dreamwork techniques. For more information, go to https://www.drleslieellis.com or contact her at leslie@drleslieellis.com.

 

References

Ecker, B., Ticic, R. & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York: Routledge.

Ellis, L. (2019). A Clinician’s Guide to Dream Therapy: Implementing Simple and Effective Dreamwork. New York & London: Routledge.

Gendlin, E. T. (1984). The client’s client: The edge of awareness. In R. L. Levant & J. M. Shlien (Eds.), Client-centered therapy and the person-centered approach. New directions in theory, research and practice, pp. 76-107. New York: Praeger.

Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy. Behavioral and Brain Sciences, 38.

Lee, J. L., Everitt, B. J., & Thomas, K. L. (2004). Independent cellular processes for hippocampal memory consolidation and reconsolidation. Science, 304, 839-843.

Pesant, N. & Zadra, A. (2004). Working with dreams in therapy: What do we know and what should we do? Clinical Psychology Review, 24, 489–512.