The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review

The clinical neuroscience of lucid dreaming

During most dreams, the dreamer does not realize that they are in a dream. In contrast, lucid dreaming allows to become aware of the current state of mind, often accompanied by considerable control over the ongoing dream episode. Lucid dreams can happen spontaneously or be induced through diverse behavioural, cognitive or technological strategies. Such induction techniques have spurred research into the potential therapeutic aspects of lucid dreams. In this review, we gather evidence on the link between lucid dreams and conditions like nightmare disorder, depression, anxiety, psychosis, and dissociative states, and highlight the possible neurobiological basis of these associations. Furthermore, we explore contemplative sleep practices that train lucid states during sleep, such as Dream/Sleep Yoga and Yoga Nidrâ. The potential drawbacks of lucid dreaming interventions are outlined, accompanied by an examination of the impacts of lucid dreams on individuals without clinical conditions. By shedding light on these intricate relationships, the review contributes to a deeper understanding of the therapeutic possibilities and implications of lucid dreaming.

The Effects of Lucid Dreaming and Nightmares on Sleep Quality and Mental Health Outcomes

OBJECTIVES

This study aimed to investigate relationships between lucid dreaming and sleep and mental health outcomes within a representative sample of the general population. We also sought to examine how nightmares interact with the relationship between lucid dreaming, sleep, and mental health outcomes.

METHODS

Participants (N = 1332) completed measures of lucid dream frequency, nightmare frequency, anxiety and depressive symptoms, stress, and sleep quality. Hierarchical regression models were conducted, where step-1 examined the direct effect of lucid dreaming on all outcome variables, and step-2 added nightmares into the equation (to examine direct effects of lucid dreaming frequency and nightmares, and the indirect effect of nightmares).

RESULTS

Step-1 results demonstrated that lucid dreaming positively predicted poor sleep quality, stress, anxiety, and depressive symptoms. Step-2 results revealed that nightmares were the only significant predictor of poor sleep quality, stress, and anxiety symptoms, accounting for all of the variance of lucid dreaming. Nightmares and the interaction of nightmares and lucid dreaming positively predicted depressive symptoms.

CONCLUSIONS

Our results suggest that nightmares alone explain associations between lucid dreaming and poor sleep quality, anxiety symptoms, and stress. However, both nightmares and the combination of nightmares and lucid dreaming are associated with increased depressive symptoms.

New strategies for the cognitive science of dreaming

Dreams have long captivated human curiosity, but empirical research in this area has faced significant methodological challenges. Recent interdisciplinary advances have now opened up new opportunities for studying dreams. This review synthesizes these advances into three methodological frameworks and describes how they overcome historical barriers in dream research. First, with observable dreaming, neural decoding and real-time reporting offer more direct measures of dream content. Second, with dream engineering, targeted stimulation and lucidity provide routes to experimentally manipulate dream content. Third, with computational dream analysis, the generation and exploration of large dream-report databases offer powerful avenues to identify patterns in dream content. By enabling researchers to systematically observe, engineer, and analyze dreams, these innovations herald a new era in dream science.

Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study

Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.

Sleep and lucid dreaming in adolescent athletes and non-athletes

During lucid dreaming (LD), dreamers are aware of experiencing a dream and may consciously influence its content. This study used an online questionnaire to investigate the LD frequency and applications in 193 adolescent athletes and non-athletes (17.40 ± 2.09 years; 46% athletes, 54% controls). Given the critical role that sleep plays in adolescent health, development, and performance, associations of LD with various sleep parameters were also explored. LD is prominent in adolescents (67.4% experienced it at least once, 30.0% once a month or more, 12.9% at least once a week), but similar in terms of frequency and uses between athletes and non-athletes. A higher proportion of those who practiced sports/dance during LD reported improved waking self-efficacy (57.1%) over sport performance (42.9%). There was no indication that chronotype preference may influence LD nor that LD may be detrimental to adolescent sleep. Athletes and controls had similar sleep durations, daytime sleepiness, and sleep disturbances frequency, but athletes reported higher sleep quality. Despite, on average, meeting the minimum sleep recommendation guidelines for their age, a relatively large proportion of adolescents did not attain sufficient sleep, particularly on weeknights (47.4% 14-17 years; 20.0% 18-21 years), suggesting that restricted sleep remains prevalent in adolescent populations.

To be or not to be hallucinating: Implications of hypnagogic/hypnopompic experiences and lucid dreaming for brain disorders

The boundaries between waking and sleeping-when falling asleep (hypnagogic) or waking up (hypnopompic)-can be challenging for our ability to monitor and interpret reality. Without proper understanding, bizarre but relatively normal hypnagogic/hypnopompic experiences can be misinterpreted as psychotic hallucinations (occurring, by definition, in the fully awake state), potentially leading to stigma and misdiagnosis in clinical contexts and to misconception and bias in research contexts. This Perspective proposes that conceptual and practical understanding for differentiating hallucinations from hypnagogic/hypnopompic experiences may be offered by lucid dreaming, the state in which one is aware of dreaming while sleeping. I first introduce a possible systematization of the phenomenological range of hypnagogic/hypnopompic experiences that can occur in the transition from awake to REM dreaming (including hypnagogic perceptions, transition symptoms, sleep paralysis, false awakenings, and out-of-body experiences). I then outline how metacognitive strategies used by lucid dreamers to gain/confirm oneiric lucidity could be tested for better differentiating hypnagogic/hypnopompic experiences from hallucinations. The relevance of hypnagogic/hypnopompic experiences and lucid dreaming is analyzed for schizophrenia and narcolepsy, and discussed for neurodegenerative diseases, particularly Lewy-body disorders (i.e. Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies), offering testable hypotheses for empirical investigation. Finally, emotionally positive lucid dreams triggered or enhanced by training/induction strategies or by a pathological process may have intrinsic therapeutic value if properly recognized and guided. The overall intention is to raise awareness and foster further research about the possible diagnostic, prognostic, and therapeutic implications of hypnagogic/hypnopompic experiences and lucid dreaming for brain disorders.