Category: Nightmares

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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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Nightmares exacerbate mental illness, but treatment helps

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In clinical settings, nightmares are rarely inquired about, and even less often treated directly. Evidence that this needs to change is mounting. On a more positive note, nightmare treatment research continues to advance – and a new method shows that adding sensory triggers can strengthen treatment effects.

Review finds nightmares may contribute broadly to mental illness

A recent review by Sheaves (2022) found that nightmares may contribute to the development of psychiatric illness rather than being merely a symptom. The paper concludes that nightmare treatment may be an avenue for reducing threat-based disorders in particular.

Thirty-five studies were assessed overall. Although most were not designed to test the effectiveness of nightmare treatment, the researchers were able to note moderate reductions in PTSD and depression post treatment, plus some reduction in anxiety and paranoia following direct treatment of nightmares. As well, while nightmares are known to increase suicide risk, two studies suggest nightmare treatment mitigates this risk.

The study has an interesting focus on network approaches to psychopathology — an interest in symptoms that account for comorbid diagnoses. For example, sleep disruption can lead to a variety of mental illnesses and thus is identified as a clinical priority.

Three Ways Nightmares Worsen Mental Health

The authors suggest nightmares generate anxiety and subsequent hyperarousal that may lead to more nightmares, a feedback loop that warrants greater clinical attention. Nightmares can also exacerbate negative mood due to their distressing content. And via yet another avenue, sleep disruption, nightmares can contribute to a range of mental health issues. While nightmares are typically associated with PTSD, half of patients with psychosis or dissociative disorders and a third of those with mood disorders also experience problematic nightmares.

This research adds to the growing base of evidence for the need to treat nightmares. The authors are suggesting here that nightmares may not be an isolated symptom, but a more of a global one, and also a causal factor in the exacerbation of many forms of mental illness. While it is difficult to tease apart what is causal and what is symptomatic, it’s clear that once nightmares become chronic, they tend to make matters worse in at least three ways: by creating anxiety that generates more nightmares, by disrupting sleep and the myriad repercussions from that, and also by adversely affecting mood, especially if the dreamer dwells on the negative content.

Nightmare treatments: Education, rescripting and now, music!

Nightmare treatment can also work along several avenues. Most treatments include some relaxation and educational components that can help assuage anxiety generated by nightmares. Sometimes simple things like letting dreamers know dream content is not literal and is often an intensified image of a situation that needs attention can bring a helpful shift in perspective. For example, dreaming of killing a parent who is angry might signify an empowered response, reflecting a desire to effectively stop the aggression. It does not indicate murderous intent!

Understanding metaphoric nature of dreams brings perspective

In my extensive work with nightmares, I see two main avenues of intervention. The first is to address the activation – in terms of the nervous system, to dissipate the sympathetic charge. Working with the dream material and making sense of it in terms of metaphor often brings a new perspective. If needed, offering information about the nature of dreaming itself often helps those whose dreams are filled with gruesome or horrific content to see that this is not reflective of their character or personality, but truly just the nature of dreaming during turbulent emotional times.

Once the dream feels more approachable, I work with the dreamer to find ways to dream it forward, first by finding allies or resources to draw upon, ideally from within the dream itself. Bolstered, the dreamers typically imagine a different way forward, one that feels better in their bodies. Often, elements of these more empowered dream stories find their way into subsequent dreams, rendering them less nightmarish. Often even recurrent nightmares change, and sometimes they simply stop.

Sound added to nightmare treatment a promising new avenue

Technological advances suggest that it is quite possible to intervene in a bad dream and shift its trajectory – from the outside as well as the inside. For example, a recent study showed that pairing a revised dream sequence with a specific sound (a piano chord), and then playing the sound every 10 seconds during the dream-rich REM phase of sleep, would help them recall the new and improved version of the dream. This worked!

Perogamvros and colleagues (2022) tried it on half of a 36-person sample. All were treated for nightmares for two weeks using Imagery Rehearsal Therapy and half had the sound added. While all experienced a reduction in nightmares, those with the addition of the piano music reported fewer nightmares and more positive dreams than the control group, and these significant shifts were still apparent three months later.

The researchers noted that it was not the sound itself, but the memory trigger that accounts for the difference. Other sounds, or smells may also work to remind the dreamer of the positive shifts they created during dream treatment. This is called ‘targeted memory activation’ (TMR), a method that has been shown to enhance memory consolidation during sleep.

 

For more on how to treat nightmares, we have a full-length course and a lecture on nightmares and the nervous system. Or check out my web site for many other posts on this topic.

 

Schwartz, S., Clerget, A., & Perogamvros, L. (2022). Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Current Biology, 32(22), 4808-4816.

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.

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Dream changes help clinicians predict suicidal behaviors

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There is a well-established link between frequent nightmares and a greater risk of suicide, but until now, there has been no sense of specifically what to watch for in a client’s dream life to signal that their risk is escalating. However, a group of researchers has just published an article on how dreams change prior to suicide attempts.

I have long been suggesting that clinicians ask about nightmares and offer treatment if warranted. This recent study underscores the importance of asking about dreams – and offers some clarity about specific ways that nightmares escalate prior to a suicide attempt.

The naturalistic study collected dream information from 40 patients that were hospitalized for suicidal crisis, and found that 80 percent of them had experienced changes in their dream lives prior to this crisis. Two-thirds experienced bad dreams, half had nightmares and 22 percent had dreams about suicide.

The researchers also noted a progression in the way dreams changed prior to the suicidal crisis, with bad dreams appearing 4 months’ prior, nightmares 3 months’ prior and suicidal scenarios 1.5 months’ prior. They concluded: “Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.”

The researchers studied the differences in those whose dream lives changes prior to their suicidal crisis versus those whose dreams stayed much the same, and found that those with altered dreaming had more of a family history of insomnia. Virtually all had symptoms of depression and altered sleep quality prior to their hospitalization.

The bottom line is that when you ask clients about their dream lives, you can also be alert to any changes. An increase in bad dreams that escalates to more frequent nightmares is an important change that may predict a suicidal crisis. Content of the dreams might provide some clues as well, though they are not going to dream about suicide specifically in most cases.

The other important consideration in your treatment of those who dream and sleep disturbance is escalating is that you can treat these as symptoms, not just as warning signs, and you may be able help them course-correct through direct attention to their nightmares. In other words, dream changes are not just diagnostic, but also avenues for treatment that may reduce suicide risk.

For more about what you can do to treat nightmares, I am offering a time-limited nightmare treatment course bundle, an in-depth online training for clinicians which includes a workshop on nightmares and the nervous system. You can check it out here.

References

Geoffroy, P., Borand, R., Ambar Akkaoui, M., Yung, S., Atoui, Y., Fontenoy, E., Maruani, J., & Lejoyeux, M. (2022). Bad Dreams and Nightmares Preceding Suicidal Behaviors.. The Journal of clinical psychiatry, 84(1), 1

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Nightmare Distress: How we experience dreams is more impactful than what we dream

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‘Mary’, a client in my clinical practice, had frequent, bloody, violent dreams and came to love them. She once dreamt of being shot point-blank but did not find this disturbing. The feeling in the dream, and in processing it after, was peaceful, almost spiritual. Another dreamer dreamt of scenes of her family around the table simply eating dinner, yet these dreams struck terror into her heart and left her feeling upset for the entire day.

It is often the case that the emotions present in a dream are not congruent with the dream scenario. There are many reasons for this, and many implications for clinicians who ask about and work with dreams and nightmares. The main point is that emotion is a key element in the dream, possibly more important than the imagery itself.

Images in dreams can be highly dramatic, metaphorical and even fantastical. The key is what they evoke. So when asking your clients about their dreams, always inquire about the emotional landscape as well as the visual one. And also understand that dream responses are something we can work with and change.

The words of Victor Frankl (1985) come to mind here: ‘Between stimulus and response, there is a space. In that space is our power to choose our response.” We can’t change the fact that our dream forest, however beautiful, is steeped in terror (unless we become lucid, but that’s another topic). However, when we process such a dream with open curiosity, we can change how we feel about it after the fact, and over time, develop a better relationship to our dreams in general.

Mary, for example, had an intense and loving relationship to her dreams, though most of them depicted frightening or violent scenes. And as we worked with them, we discovered that these intense dreams were particularly powerful for engendering deep emotion and change. This is why, as a long-term dream therapist, I look at dream content from a not-knowing stance, never assuming a dream is as bad (or good) as it appears. Instead, I accompany the dreamer on a search for cues of safety and support, and from this place of relative comfort, the whole dream can look and feel very different from the first impression it may have made.

A recent study (Mathes et al., 2022) into nightmare distress confirms much of this clinical experience I describe. The researchers confirmed earlier findings that the level of distress a nightmare brings is significantly influenced by exposure to childhood trauma, and acutely stressful life events. However, violent dream content was less impactful for the 103 participants with frequent nightmares than the emotions they experienced in response to their dreams, a result they did not expect.

The study tracked 103 participants, 59 of whom experienced frequent nightmares, measuring dream recall, nightmare distress, levels of childhood trauma, dream emotions and violent content, and distress related to current life events. The notion that current stressors can bring nightmares, especially for those with a history of adversity, was supported and offers an explanation for the increase in nightmare frequency and distress during the worst of the global COVID pandemic, for example.

However, your response and your attitude towards such dreams can make a real difference to the level of distress they cause. A recent study by Schredl (2021) supports this idea. He found that attitudes toward nightmares and also levels of neuroticism impact how nightmares affect us. But while we can’t change our history of adversity or alter many of life’s stressors, we can change our attitudes and responses toward our dreams. The more we learn and understand about nightmares, and the more we can turn toward our dreams with calm curiosity, the less they are likely to cause distress.

The conclusion Mathes reached about nightmare distress is that “emotional appraisal has a substantial influence on nightmares. This suggests that dreamers can influence dream experiences due to their reappraisal during the dream and probably also in waking life.” My substantial clinical experience working with nightmares suggests that latter is true and may affect the former. In other words, if we befriend our dreams in waking life, we are also more likely to do so within the dreams themselves.

For example, in a few nightmare treatment sessions, I invited ‘Paula’, who experienced frequent recurring nightmares, to gather up any helpful elements she could find in her dreams. She then began to do this from within the dreams. Her nightmares were always harrowing chase scenes, but as she became more curious and comfortable with them, she developed superpowers within the dreams, such as the ability to fly away or disappear. More importantly her feelings around the dreams shifted from abject terror to a sense of adventure. And while the content of these recurring dreams still often begins in similar way, her response, both within and after the dream, has shifted to the point where she would no longer call these dreams nightmares.

 

References

Frankl, V. E. (1985). Man’s search for meaning. Simon and Schuster.

Mathes, J., Schuffelen, J., Gieselmann, A., & Pietrowsky, R. (2022). Nightmare distress is related to traumatic childhood experiences, critical life events and emotional appraisal of a dream rather than to its content. Journal of Sleep Research, e13779.

Schredl, M. (2021). Nightmare distress, beliefs about nightmares, and personality. Imagination, Cognition and Personality, 40, 177-188.

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Nightmares Quadruple Adolescent Suicide Risk

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Nightmares quadruple suicide risk in youth, yet overlooked by most clinicians

Scary dreams are common among children, and possibly it is for this reason that they are often overlooked by clinicians. In fact, frequent nightmares can indicate a life-threatening state. It has been well established that nightmares are robustly linked with higher suicide risk in adults, and a recent study has extended this to adolescents.

Children with frequent nightmares are twice as likely to consider suicide and four times more likely to attempt it than kids with fewer nightmares. It’s normal in childhood to have some nightmares, but frequent, chronic, distressing dreams indicate nightmare disorder, which warrants clinical attention, something too few nightmare sufferers receive.

 

Clinicians drastically underestimate nightmare prevalence

In a recent study, Corner and colleagues (2022) looked at reported rates of nightmare disorder among 806 child psychiatric outpatients, asking both children and their parents about prevalence of nightmares. The researchers found that parents reported 40 percent of these children had nightmares, while 56 percent of the children said they had experienced a nightmare the previous week. Of these children, just 12 (0.01%) had been diagnosed with nightmare disorder, and 16% were given a posttraumatic stress disorder (PTSD) diagnosis. It appears parents underestimate the prevalence of their childrens’ nightmares by a little, and clinicians underestimate by a lot – if they consider nightmares at all.

The researchers found that very few children in this sample with chronic nightmares had been identified, yet many families expressed desire for treatment for their children. Their conclusion: “We join with researchers of adult populations in calling for routine screening of nightmares.”

A recent systematic review of the prevalence of nightmares in youth found that in clinical populations, 27% to 57% reported nightmares in the previous week and 18% to 22% in the previous month (El Sabbagh et al., under review). By contrast, 1% to 11% of those without a clinical diagnosis reported having a nightmare in the previous week, and 25% to 35% in the past month. Clearly, nightmares are highly prevalent in those children with mental health concerns.

 

Childrens’ nightmares are highly prevalent, mostly undiagnosed, yet treatable

The hard part of this story is that so many of those with nightmare disorder are undetected and therefore untreated, despite the availability of effective therapies. For example, a recent study looked at treatment of childrens’ nightmares using a sample of 17 children aged 5 to 17. While the researchers were exploring some of the nuances of such treatment, the first important point is that the treatment was effective, with high effect sizes across the board.

The sample was too small to draw firm conclusions about the efficacy of the treatment used – five cognitive-based sessions, including psychoeducation and rewriting the nightmare. However, it does support the considerable evidence that nightmares are treatable.

In this particular study, Pangelinan and colleagues (2022) wanted to know which was reduced first during treatment: nightmare frequency or distress. Because the distress caused by nightmares is considered a driving force in recurrent dreams, the researchers expected distress to drop before frequency, but found the opposite to be the case. Yet both factors were steadily reduced over time, after an initial spike in the distress levels, possibly caused by focusing on the nightmares more than usual.

What makes nightmare treatment effective continues to be a bit of a puzzle and potentially many factors contribute to the success of treatment. I suggest, in my recent article on nightmares and the nervous system (Ellis, 2022), that it is a sense of safety at a physiological level that could underlie nightmare treatment success, and this can be achieved in many ways. Some of these factors are alluded to by Pagelinan: “The steady decline of nightmare frequency and distress over time supports the idea that nightmare treatment is not about an on-off switch of sorts but rather a process by which different skills that address efficacy, hope, relaxation, and sleep skills, in addition to the emotion processing of a nightmare through exposure and rescription, may be important in nightmare treatments.”

The main point here is that while there are many more things to understand about how to treat nightmares, we know enough already to make a real difference. The larger problem we currently face is lack of awareness that nightmares are so prevalent in the clinical population, and that they represent both risk and opportunity.

I am offering a more comprehensive course for clinicians called The Nightmare Treatment Imperative.  Learn why treating nightmares is both essential and surprisingly simple.

 

References

Cromer, L. D., Stimson, J. R., Rischard, M. E., & Buck, T. R. (2022). Nightmare prevalence in an outpatient pediatric psychiatry population: A brief report. Dreaming. Advance online publication. https://doi.org/10.1037/drm0000225

Ellis, L. A. (2022). Solving the nightmare mystery: The autonomic nervous system as missing link in the aetiology and treatment of nightmares. Dreaming.

Pangelinan, B., Rischard, M. E., & Cromer, L. D. (2022). Examining changes in nightmare distress and frequency across treatment in a child sample: Which improves first? International Journal of Dream Research, 15(2), 198-204.

 

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Terror and excitement are not so far apart

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Nervous system hybrid states and how they show up in dreams 

Not all dreams are pure fight/flight, but much like our complex nervous systems they can express hybrid states. We are all familiar with the nightmares of being chased (flight response) or weighed down with helpless immobility (dorsal vagal response). These are fear-based dreams, but they take on a very different tone when imbued with a sense of safety.

At its most basic level safety allows for social engagement, a sense of being at home in the company of those we love and trust. There are also hybrid states, where how safe we feel can mediate how our nervous system responds. When we are immobilized with safety, this allows for stillness, intimacy and bonding. When we are activated with safety, this allows for excitement, sport and play.

The genius of the polyvagal theory developed by Dr. Stephen Porges is that it takes us beyond the simple categorization everyone rattles off without much thought – the well-known fight/flight/freeze paradigm. When naming and understanding our autonomic state, Porges puts safety first.

A neuroception of safety is automatic, not intellectual

What does Porges mean by safety? His polyvagal theory is referring not to literal safety, but rather, bodily-sensed safety. Many who experience activated nervous systems, fear responses and nightmares are not in any real, physical danger, but there is no way to convince them of this, at least not by simply saying so.  Porges’ model stresses the neuroception of safety, that full-body sense which happens automatically, beyond conscious control, that allows our system to relax and repair.

When we are not experiencing rejuvenating embodied safety (a ventral vagal state), our dreams come as nightmares, as being chased or in aggressive encounters (fight/flight) or as helplessness immobility (often called freeze, those this word is not quite accurate). When our bodies feel safe, we dream of social encounters, of intimacy, adventures and play. Our dreams depict how safe or endangered we feel. As such, they can be a doorway to shifting these states at a deep level.

Autonomic state shifts are common — our nervous systems are always working to balance the need for safety and self-protection with those of social engagement, healing, digestion and the achievement of homeostatic balance. When our system perceives threat, things like digesting food or making love are luxuries our bodies senses we can’t afford… whether or not this is actually true.

Our sense of safety or danger is not always accurate

How do our bodies get this wrong? Much of the mismatch comes from early programming, from chronic exposure to neglect or trauma that creates nervous system responses that are either too sharp, too dull or a mixture of both. Those with complex trauma histories, for example, can perceive danger where none exists, or be blithely unaware of actual threatening situations and walk into danger without knowing it. Our dreams can provide both clues and solutions as they reflect our unconscious ANS responses.

During typical sleep, we shift states many times, alternating periods of deep restorative sleep with progressively longer period of dream-rich rapid-eye movement (REM) sleep. In these state shifts, we are most likely to become aware of our dreams and to be awakened by those that are particularly intense. Nightmares can disrupt sleep and affect mood, but they can also open the door to autonomic state shifts that can be lasting.

If we approach our dreams with curiosity, and begin to cultivate mastery and degrees of lucidity, we may be able to shift our dreamscape from a pervasive sense of threat to one of safety, changing our whole experience of the dreaming. This is easier to do that one might think. One chronic nightmare sufferer I worked with was able to turn a face her pursuers and discovered they were far less threatening than expected, and this changed the nature of her dreams. The chase dreams still visit at times, but now they have taken on more of an adventurous feel, one of excitement rather than terror – a similar activated state, but with more of a sense of safety.

Hybrid states show us that the programming our nervous systems received early in life may be tenacious, but it is also malleable. Change is possible, and dreams are one pathway to understanding and altering our habitual responses.

For more on this topic, join Dr. Leslie Ellis for a workshop on Nightmares and The Nervous System October 13, from 9:30-noon (Pacific)

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Nightmares and the nervous system: How the content of your nightmares can guide recovery from disturbed dreaming

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The content of our dreams offers clues about the state of our nervous system. As we know from current research on recurrent dreams, these often depict being chased, feeling helpless or, if positive, represent ways of being socially engaged. Anyone familiar with the polyvagal theory will recognize these states as the some of the main expressions of different states of autonomic nervous system (ANS): being chased is fight/flight, helplessness is immobility and social engagement corresponds with the ventral vagal state the body enters when feeling safe.

A new wave of somatically-oriented trauma therapies has swept through the field of trauma treatment as a result of what we now know about the nervous system. I love that these new approaches view ANS responses as adaptive rather than pathological. I am also impressed at how neatly such constructs map onto dream content. Clinicians can use this information from dreams to inform diagnosis and treatment, and to map clinical progress. For example, when recurrent dreams change, this is can indicate clinical progress as it coincides with increased well-being.

My upcoming journal article, Solving the Nightmare Mystery: How Polyvagal Theory Updates Our Understanding of the Aetiology and Treatment of Nightmares, takes Porges’ polyvagal theory and the nervous system into account when considering the causes and treatment of nightmares; it is in the final stages of production for APA journal Dreaming. The article articulates both a theory and treatment approach that I will cover in more detail in my upcoming workshop on October 13 (participants will receive an advance copy). One of the practical take-aways is the matching of dream content with autonomic states. Here is an excerpt from my article:

“It is possible to map the hierarchy of threat responses onto the content of nightmares. Virtually all fear-based nightmares contain material that represents either an activated fight/flight response or a helpless immobilized response in the face of threat. A recent study to determine the main themes in nightmare content (n = 1216) points to a strong, though not perfect, correlation between most common nightmare themes and the polyvagal response hierarchy. In order, the most frequent nightmare themes identified by Schredl and Goritz (2018) were failure or helplessness (immobility), physical aggression (fight), accidents, being chased (flight), illness or death (immobility), and interpersonal conflict (fight).”

In my doctoral research, I conducted a related qualitative study (Ellis, 2016), looking at changes in recurrent nightmare content after treatment using a protocol that is a precursor to the Nightmare Relief protocol I now use and teach.  The recurrent nightmares of study participants changed after treatment toward more empowered responses, moving up the polyvagal hierarchy of threat responses — from immobility to flight to fight. Also, the dreams that came after treatment began to weave in current settings and characters from the dreamer’s life shifting away from a focus in past trauma. The progression of dream content from replicative and recurrent toward dreams with strange twists and temporal anomalies (ie more normal dreaming) often coincides with trauma recovery.

Relevant to polyvagal theory, I also noticed that the dreams post-treatment tended to move toward greater social engagement: “When dreamers were asked to rescript their dream endings, they almost invariably imagined ‘home.’ The quality of home is similar to Porges’ ventral vagal state: not necessarily a literal place (especially for those whose actual homes were unsafe), but rather a sense of safety in the company of trusted others.” This is a clue about how to help with nightmares – assisting dreamers to reimagine their dreams in ways that feel safer can shift them, and reduce the aversion nightmare sufferers tend to have toward sleep and dreams.

In my upcoming seminar, I will present the most salient aspects of this material and focus mainly on introducing the Nightmare Relief protocol. I will be able to offer more detail, clinical examples, demos and experiential practices than are covered in the academic paper. I would like those who take this workshop to be able to put these ideas into practice right away with clients who suffer from nightmares and disturbing dreams.

To sum up, I have arrived at the idea that the nervous system is deeply implicated in nightmare suffering, and that using newer embodied trauma treatment methods that instill a sense of safety and connection are the starting points for treatment. I have incorporated what I learned in my doctoral research, and also what I have learned from existing evidence-based treatment to develop an individualized, embodied approach to treatment. This is described in my paper and upcoming workshop. I do hope you’ll join me.

 

Workshop: Nightmares and the Nervous System: How to treat disturbed dreaming
October 13, 9:30 to noon Pacific
LIVE online via Zoom, recording available to registrants
Cost: 140 (plus GST) = $147 USD

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Experiential dreamwork program doubles student confidence in exploring dreams

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I am always trying to improve my programs, so I asked my most recent cohort how their comfort level and ways of working with dreams have changed over the past year as a result of participating in my Embodied Experiential Dreamwork program. It is so gratifying to hear how many deepened and freed up their relationship to dreams. On average students started with a comfort level of 3/10 in their dreamwork practice, and ended up at 7, more than doubling their collective confidence in working with dreams.

I have gathered some representative comments from the recent exit survey. These might be especially useful for those of you considering taking this program – the next cohort begins September 21, and there are still a few spaces.

One student, who prefers to remain anonymous said that as a result of taking the program: “I have been more motivated to dive deeply into my dreams, to spend extra time with them, to come back to them. It is now easier for me to explore a dream from the felt sense as opposed to analyzing and interpreting. Perhaps what I appreciate the most is the concept of how dreams have a life of their own, and that working with them changes them… Now it is easier for me to make space for whatever shows up.”

She continued: “The videos, podcasts, and articles were well organized and very clearly presented. The materials offered were very generous, over and above expectation. Class time was amazing, and it was good to have most of it be experiential. Leslie is a master at working with dreams and facilitating the group experience, in addition to having a solid basis from an academic perspective… This course was more than I hoped for, and I can’t imagine it being any better!”

Carrie Moy, a focuser in training, wrote: “This program teaches you a powerful way to work with your own dreams and those of others.  My connection to my dream life has deepened considerably as result of this program.  I have developed reverence for and love of my dreams, and I feel this has had the secondary impact of me increasing compassion and tenderness towards myself. I also have enjoyed working with others’ dreams in group processes.  It has brought heart-opening connection during these uncertain times.”

Michelle Carchrae, a registered clinical counsellor, said: “Now that I’ve had direct experience of doing dreamwork as a client, I know that it works and I have a sense of what it feels like when it does work. I have more trust in the process as well as an intellectual framework and steps in a process that can guide me when doing this work with clients.”

Markel Méndez, a Jungian oriented art and psychodrama therapist, said, “Now I am less worried about meaning or interpretation and more focused on experience and body sensations. In this new path, I found more creativity.”

Walter Smith, a retired minister and spiritual director, said: “This class gives particpants the ability to feel at ease in dealing with their own dreams while at the same time opens many different ways dream workers deal with dreams. It is an exciting way to become engaged with the larger dream world.”

Regarding quality of instruction, Smith wrote, “Leslie has a beautiful gift of creating an open and safe place for people to share dreams. Her presentation skills are top-notch. She never seems rushed, and presents in a clear and concise manner. This class was worth every penny. Not a single minute or dollar was wasted. Taking this class was one of the best decisions I ever made.”

Rocio Aguirre, a coach and meditation teacher tells prospective students: “You will increase your confidence to work with your own dreams and the dreams of others. You will have a greater understanding of trauma-related nightmares and how to work with them… and you will be in the hands of an expert in dreams and dreamwork. Leslie is always looking for new research and keeping us updated during the course.”

Head of PhD Studies at University of California, professor Anthony Kubiak summed it up by writing: “I would recommend this course without reserve. It gave much more confidence going forward with my own and others’ dreamwork.”

Spiritual director Nancy Finlayson commented on the extensive online materials that come with the course: “Loved it. I really appreciated the quality and content. It helped me grasp the concepts and bring them into practice… Leslie is an excellent instructor whose passion for dream work is contagious!”

There is more… and I am so humbled and pleased that everyone gave me the highest rating as an instructor. There were also some ideas for improvement, and I will be adopting these in the next cohort, which begins Sept. 21 and runs from 9:30 to noon on Wednesdays for the coming year (skipping December). Robbyn Peters Bennett will also be teaching the class with me. We do hope you will join our amazing dream study community.

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Nightmares and the nervous system: a new approach to treatment based on polyvagal theory

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At long last, my article that takes Porges’ polyvagal theory and the nervous system into account when considering the causes and treatment of nightmares, has been accepted for publication in the APA journal Dreaming. Although it could be many months before it is actually published, I am happy to share some of the main ideas and invite you to an online workshop on nightmare treatment based on this research. Those who sign up will receive an advance draft copy of the article, Solving the Nightmare Mystery: How Polyvagal Theory Updates our Understanding of the Aetiology and Treatment of Nightmares.

Here is the abstract: “Current theories about the aetiology of nightmares and mechanisms of action that account for their successful treatment have not yet taken the polyvagal theory (Porges, 2011) into consideration. While the polyvagal theory’s updated and multi-faceted view of the autonomic nervous system’s (ANS) response to threat has begun to transform the field of trauma treatment, most of these ideas have not yet been applied to nightmares and their treatment. This paper outlines how the theory may provide a missing link in understanding specific ways that trauma and adversity lead to chronic nightmares, and it offers a way to make sense of the heterogeneity of trauma-related symptoms and concomitant responses to nightmare treatments. A review of the literature demonstrates evidence of links between measures of ANS and physiological responses to nightmares. Content similarities between threat responses described by polyvagal theory and common nightmare themes provides an additional avenue for assessment and intervention. Theories of nightmare aetiology and treatment are evaluated with respect to polyvagal theory, and lastly, a proposed treatment protocol, Nightmare Relief, offers a polyvagal-informed, process-experiential approach to treating nightmares, with links to clinical examples.”

This sounds like quite a mouthful. In my upcoming seminar, I will present the most salient aspects of this material and focus mainly on introducing the Nightmare Relief protocol. I will be able to offer much more detail, clinical examples, demos and experiential practices than are covered in the academic paper. I would like those who take this workshop to be able to put these ideas into practice right away with clients who suffer from nightmares. Students of mine who have learned this way of working tell me it has stopped the nightmares of some of their clients.

What inspired me to spend the last couple of years on this enormous project? It stems from my experience as a trauma therapist, and many forces have converged to lead me to this focus on treating nightmares. In my 25 years working with posttraumatic stress injury and complex trauma, I have watched the practice of trauma treatment evolve, bringing more embodied practices and deep empathy into the work. I have enjoyed the move away from pathologizing stances toward a deeper understanding of the nervous system’s response to threat and ideas about how to help clients understand and befriend their bodies.

In the past few years, I completed a PhD with a focus on using focusing-oriented therapy, a gentle embodied approach to psychotherapy, for treating the nightmares of refugees. Encouraged by the results, I have continued to study nightmare treatment and was alarmed to discover two things: how few clinicians are versed in this important skill, and how imperative it is to treat nightmares. They are robustly linked to increased suicide risk, and associated not only with posttraumatic stress, but virtually all forms of mental health disturbance. The available treatments appear to work, but not necessarily for the most severe cases, and there is room to understand more about what works and why.

I have arrived at the idea that the nervous system is deeply implicated in nightmare suffering, and that using newer embodied trauma treatment methods that instill a sense of safety and connection are the starting points for treatment. I have incorporated what I learned in my doctoral research, and also what I have learned from existing evidence-based treatment to develop an individualized, embodied approach to treatment. This is described in my paper and upcoming workshop. I do hope you’ll join me.

Workshop: Nightmares and the Nervous System: How to treat disturbed dreaming
October 13, 9:30 to noon Pacific
LIVE online via Zoom, recording available to registrants
Cost: 140 (plus GST) = $147 USD

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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.