Austrian dream behavior: Results of a representative population survey

The role of mindful acceptance and lucid dreaming in nightmare frequency and distress

A theoretical and empirical association between lucid dreaming and mindfulness, as well as lucid dreaming and nightmares has previously been observed; however, the relationship between nightmares and mindfulness has received surprisingly little attention. Here, we present the findings of two studies exploring the relation of nightmare frequency and distress with two components of mindfulness, termed presence and acceptance, as well as lucid dreaming. Study 1 (N = 338) consisted of a low percentage of frequent lucid dreamers whereas Study 2 (N = 187) consisted primarily of frequent lucid dreamers that used lucid dream induction training techniques and meditation. Across studies, nightmare-related variables showed a more robust association with mindful acceptance as opposed to mindful presence. Moreover, individuals with high levels of meditation expertise and practice of lucid dreaming induction techniques reported lower nightmare frequency. Finally, in Study 2, which consisted of frequent lucid dreamers, a positive correlation between lucid dreaming frequency and mindfulness was apparent. The present findings support the notion that wakeful mindfulness is associated with the quality of dreams and extend previous research by suggesting a disentangled role of the two facets of mindfulness in dream variation. This association remains open for experimental manipulation, the result of which could have clinical implications.

M, T. F, M. M, A. S, G. H, M. J, L. G, L. B, T. Z. L, B. H, S. R, S. MR. Lucid dreaming increased during the COVID-19 pandemic: An online survey

The COVID-19 pandemic changed people’s lives all over the world. While anxiety and stress decreased sleep quality for most people, an increase in total sleep time was also observed in certain cohorts. Dream recall frequency also increased, especially for nightmares. However, to date, there are no consistent reports focusing on pandemic-related changes in lucid dreaming, a state during which dreamers become conscious of being in a dream as it unfolds. Here we investigated lucid dreaming recall frequency and other sleep variables in 1,857 Brazilian subjects, using an online questionnaire. Firstly, we found that most participants (64.78%) maintained their lucid dream recall frequency during the pandemic, but a considerable fraction (22.62%) informed that lucid dreams became more frequent, whereas a smaller subset (12.60%) reported a decrease in these events during the pandemic. Secondly, the number of participants reporting lucid dreams at least once per week increased during the pandemic. Using a mixed logistic regression model, we confirmed that the pandemic significantly enhanced the recall frequency of lucid dreams (p = 0.002). Such increase in lucid dreaming during the pandemic was significantly associated with an enhancement in both dream and nightmare recall frequencies, as well as with sleep quality and symptoms of REM sleep behavior disorder. Pandemic-related increases in stress, anxiety, sleep fragmentation, and sleep extension, which enhance REM sleep awakening, may be associated with the increase in the occurrence of lucid dreams, dreams in general, and nightmares.

Personality Traits and Insomnia Symptoms in Shift Workers

The discrepancy between natural sleep-wake rhythm and actual sleep times in shift workers can cause sleep loss and negative daytime consequences. Irregular shift schedules do not follow a fixed structure and change frequently, which makes them particularly harmful and makes affected individuals more susceptible to insomnia. The present study compares insomnia symptoms of non-shift workers, regular shift workers, and irregular shift workers and takes into account the moderating role of the Big Five personality traits and levels of perfectionism. Employees of an Austrian railway company completed an online survey assessing shift schedules, sleep quality and duration, daytime sleepiness, and personality traits. A total of 305 participants, of whom 111 were non-shift workers, 60 regular shift workers, and 134 irregular shift workers, made up the final sample. Irregular shift workers achieved significantly worse scores than one or both of the other groups in time in bed, total sleep time, sleep efficiency, sleep duration, sleep quality, sleep latency, and the number of awakenings. However, the values of the irregular shifts workers are still in the average range and do not indicate clinical insomnia. Participants working regular shifts reported the best sleep quality and longest sleep duration and showed the least nocturnal awakenings, possibly due to higher conscientiousness- and lower neuroticism scores in this group. Agreeableness increased the effect of work schedule on total sleep time while decreasing its effect on the amount of sleep medication taken. Perfectionism increased the effect of work schedule on time in bed and total sleep time. Generalization of results is limited due to the high percentage of males in the sample and using self-report measures only.

"Pandemic Dreams are Susceptible to Priming and Unrelated to COVID-19 Exposure"

"Surveys that have recruited participants through social media and news websites have led researchers and clinicians to conclude that the COVID-19 pandemic has precipitated a parallel pandemic of nightmares that reflect pandemic-induced psychological distress. Many of these surveys were administered to participants who intentionally opted into research knowing that the investigators were soliciting pandemic dream reports. This investigation surveyed 193 college students who were blind to the purpose of the study to assess the prevalence of pandemic dreams and to determine if the wording of the questions could shape responses. Fewer than half could recall a dream. Reports were brief, susceptible to priming, and unrelated to personal SARS-CoV-2/COVID-19 exposure. Although this sample was not truly random, it is probably more representative of the US population than those recruited through thematic websites. Clinicians should be aware of problems inherent in survey research and understand how their words can shape client responses."

The Effects of Sleep Quality on Dream and Waking Emotions

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three ‘Good Sleepers’ (GS) and 27 ‘Poor Sleepers’ (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies.

Effects of nightmares on the cortisol awakening response: An ambulatory assessment pilot study

Previous studies have reported an association between sleep-related factors such as sleep duration, sleep quality and time of awakening with the cortisol awakening response (CAR). Preliminary evidence suggests that frequent nightmares are associated with a blunted CAR. In the present pilot study we investigated the effect of acute nightmares on the CAR and the cortisol profile of the subsequent day using a within-subject ambulatory assessment study design. Thirty healthy volunteers who reported frequent nightmares enrolled in the study. Over a period of 14 days, salivary samples in addition to sleep-related and state variables were collected at home over the day. Salivary profiles of free cortisol and alpha amylase for up to two days following a nightmare were compared to those following a neutral dream. Overall, mood and health were decreased and the CAR was elevated following nightmares compared to neutral dreams. No differences were found for alpha amylase and for all variables over the remaining part of the day. Results suggest that sleep-related factors such as the occurrence of nightmares account for a certain amount of variance observed in the CAR. This has important methodological implications for CAR studies in general and might have even more relevance for studies in clinical populations suffering from chronic sleep disturbances.

Nightmares, Chronotype, Urbanicity, and Personality: An Online Study

Chronotype refers to individual differences in sleep timing ("owls" and "larks") and "eveningness" has been associated with nightmares. However, it has not been tested as to whether neuroticism mediates this relationship. Urbanicity refers to being raised in an urban region and/or currently living in an urban region and is associated with heightened risk for developing mental disorders, and thus might be related to nightmare frequency and nightmare distress. Overall, 2492 persons (1437 women, 1055 men) completed an online survey between 23 March 2015 and 8 April 2015. The mean age of the sample was 47.75 ± 14.41 years. The findings indicate that the previously reported relationship between chronotype and nightmare frequency was mediated by neuroticism and "morningness" was related to higher dream recall compared to persons with a late bedtime preference. Urbanicity was not related to nightmare frequency but to lower nightmare distress, raising the interesting question as to whether beliefs about nightmares might be an important variable that contributes to nightmare distress. Based on the few studies so far, there are still many unresolved questions about the interaction between nightmares, chronotype, and urbanicity.

Is There a Link Between Frequency of Dreams, Lucid Dreams, and Subjective Sleep Quality?

A lucid dream is a dream in which one is conscious of dreaming and can possibly control the dream or passively observe its unfolding. Frequencies of lucid dreaming (LD), dream with awareness, and dream with actual control were previously investigated in a French student population. As a student population usually differs on oneiric and sleep characteristics (such as sleep quality) from the general population, more investigations were needed. Additionally, it is yet unresolved if LD is related to one's overall sleep quality. This study aims at describing and comparing dream experience frequencies (dream, lucid dreams, awareness, and control) and sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) among students (n = 274) and in a general population sample (n = 681). It also aims at evaluating if dream experience frequencies can predict sleep quality across these two samples. Predictive models of PSQI score controlling for age and gender were not significant in the student group while they were all marginally predictive for the general population. However, none of these models showed that the frequency of dream experiences could actually help predict the quality of sleep as the significance of the model was carried over only by the gender variable. These results are discussed in line with previous studies on LD frequencies. Several methodological adjustments for future study are proposed.

Nightmare experience and family relationships in healthy volunteers and nightmare disorder patients

BACKGROUND

Nightmares are associated with parental bonding styles and various psychiatric disorders, but the exact connections between different nightmare experience features and family relationships in healthy volunteers and nightmare disorder patients are still unclear.

METHODS

We therefore invited 62 nightmare disorder patients and 135 healthy volunteers to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Family Relationship Questionnaire (FRQ), and the Plutchik - van Praag Depression Inventory (PVP).

RESULTS

Besides the higher nightmare frequency and the higher PVP and four NEQ scale scores, the nightmare disorder patients had higher scores of FRQ Paternal Abuse, and lower ones of General Attachment, Maternal Encouragement, Maternal Freedom Release, and Paternal Freedom Release. The PVP was correlated with some NEQ and FRQ scales in both healthy volunteers and patients, and it functioned as a mediator between Physical Effect and Maternal Dominance in patients. Regarding predicting NEQ by FRQ, Paternal Abuse predicted Physical Effect, Maternal Dominance predicted Physical Effect and Horrible Stimulation, General Attachment predicted Horrible Stimulation (-) in healthy volunteers; Maternal Dominance predicted Physical Effect, Meaning Interpretation, and Horrible Stimulation, Paternal Freedom Release predicted Physical Effect (-), and Paternal Dominance predicted Meaning Interpretation and nightmare frequency in patients.

CONCLUSIONS

Our study has demonstrated that the inappropriate family relationships were linked with different aspects of nightmare experience, especially in nightmare disorder patients.

Mental Sleep Activity and Disturbing Dreams in the Lifespan

Sleep significantly changes across the lifespan, and several studies underline its crucial role in cognitive functioning. Similarly, mental activity during sleep tends to covary with age. This review aims to analyze the characteristics of dreaming and disturbing dreams at different age brackets. On the one hand, dreams may be considered an expression of brain maturation and cognitive development, showing relations with memory and visuo-spatial abilities. Some investigations reveal that specific electrophysiological patterns, such as frontal theta oscillations, underlie dreams during sleep, as well as episodic memories in the waking state, both in young and older adults. On the other hand, considering the role of dreaming in emotional processing and regulation, the available literature suggests that mental sleep activity could have a beneficial role when stressful events occur at different age ranges. We highlight that nightmares and bad dreams might represent an attempt to cope the adverse events, and the degrees of cognitive-brain maturation could impact on these mechanisms across the lifespan. Future investigations are necessary to clarify these relations. Clinical protocols could be designed to improve cognitive functioning and emotional regulation by modifying the dream contents or the ability to recall/non-recall them.

Sleep and dream habits in a sample of French college students who report no sleep disorders

There is a lack of up-to-date data on sleep and dream habits of college students. To fill in this gap, we used an online questionnaire sent to the student mailing lists of two major universities of Lyon (Lyon 1 and Lyon 2) for the recruitment of an functional magnetic resonance imaging study with sleep disorders as exclusion criteria. In the sample (1,137 French college students, 411 males, mean age = 22.2 ± 2.4 years, body mass index = 22.0 ± 3.2 kg m^-2 ), on average, the participants reported spending about 8 hr in bed during weekdays, 9 hr during the weekends, and 90.9% of them reported no difficulty falling asleep. Less than 0.4% of students reported to have sleep-walking episodes regularly, but nearly 7% reported regular sleep-talking episodes. The average dream recall frequency was about 3 mornings per week with a dream in mind. Dream recall frequency was positively correlated with the clarity of dream content and the frequency of lucid dreaming, and was negatively correlated with age. Fourteen percent of the students reported frequent lucid dreams, and 6% reported frequent recurrent dreams. We found a gender effect for several sleep and dream parameters, including dream recall frequency and time in bed, both of which were higher in women than in men. We have also observed differences between academic disciplines, namely humanities students (Lyon 2) reported spending more time in bed than sciences students (Lyon 1). These results confirm a gender difference for several sleep and dream parameters, and suggest a link between academic disciplines and sleep duration.

Dream Recall Frequency by Socioeconomic Status of Chinese Students

Whereas the effect of sex and age on dream recall have been studied widely, socioeconomic status has rarely been investigated. However, two studies reported that higher socioeconomic status was related to greater frequency of dream recall. In the present sample of 612 Chinese students from three different schools, one elite (high socioeconomic status), one rural (low socioeconomic status) and one intermediate, analysis of variance indicated no significant association between frequency of dream recall and socioeconomic status. Researchers could investigate whether “dream socialization,” e.g., encouragement of a child to remember his dreams, depends on socioeconomic background, whether these processes are mediated by culture.

Investigating on the Methodology Effect When Evaluating Lucid Dream

Lucid dreaming (LD) is a state of consciousness in which the dreamer is aware that he or she is dreaming and can possibly control the content of his or her dream. To investigate the LD prevalence among different samples, researchers have used different types of methodologies. With regard to retrospective self-report questionnaire, two ways of proceeding seem to emerge. In one case, a definition of LD is given to participants (“During LD, one is–while dreaming–aware of the fact that one is dreaming. It is possible to deliberately wake up, to control the dream action, or to observe passively the course of the dream with this awareness”), while in the other instances, participants are presented separate questions targeting specific LD indicators (dream awareness and dream control). In the present study, we measured LD frequency in a sample of French student in order to investigate for possible disparities in LD frequency depending on the type of questionnaire as outlined above. Moreover, we also study links between the prevalence of LD as assessed, respectively, by each questionnaire with various factors such as Vividness of Mental Imagery and Parasomnia. Results revealed no significant difference between LD frequencies across questionnaires. For the questionnaire with definition (DefQuest), 81.05% of participants reported experience of LD once or more. Concerning the questionnaire based on LD indicators (AwarContQuest), 73.38% of participants reported having experienced LD once or more. However, with regard to the correlations analysis, links between LD prevalence and factors such as Vividness of Mental Imagery and Parasomnia, varied across questionnaires. This result is an argument suggesting that researchers should be careful when investigating links between LD and other factors. The type of methodology may influence findings on LD research. Further studies are needed to investigate on the methodology effect in LD research namely on the respective weight of awareness and control.

Factors Influencing the Gender Difference in Dream Recall Frequency

The results of the present study confirmed earlier findings of heightened dream recall frequency in women. The variables “meaningfulness of dreams” and “occurrence of problem-solving dreams” significantly reduced the correlation coefficient between gender and dream recall frequency. However, the question of causality remains unsolved. Other variables such as emotional intensity of dreams or nightmare frequency did not affect the relationship between gender and dream recall in a substantial way. Future research should manipulate systematically the variables under consideration, e.g., attitude toward dreams in order to observe the effects of this procedure on dream recall frequency and focus on the development of the gender difference during childhood and adolescence in relation to the child's understanding of the dream phenomenon.

Winter is coming: nightmares and sleep problems during seasonal affective disorder

Sleep problems, especially nightmares and insomnia, often accompany depression. This study investigated how nightmares, symptoms of insomnia, chronotype and sleep duration associate with seasonal affective disorder, a special form of depression. Additionally, it was noted how latitude, a proxy for photoperiod, and characteristics of the place of residence affect the prevalence of seasonal affective disorder and sleep problems. To study these questions, data from FINRISK 2012 study were used. FINRISK 2012 consists of a random population sample of Finnish adults aged 25-74 years (n = 4905) collected during winter from Finnish urban and rural areas spanning the latitudes of 60°N to 66°N. The Seasonal Pattern Assessment Questionnaire was used to assess symptoms of seasonal affective disorder. Participants with symptoms of seasonal affective disorder had significantly increased odds of experiencing frequent nightmares and symptoms of insomnia, and they were more often evening chronotypes. Associations between latitude, population size and urbanicity with seasonal affective disorder symptoms and sleep disturbances were generally not significant, although participants living in areas bordering urban centres had less sleep problems than participants from other regions. These data show that the prevalence of seasonal affective disorder was not affected by latitude.

Studies with lucid dreaming as add-on therapy to Gestalt therapy

OBJECTIVES

The aim of the present exploratory clinical study was to evaluate LD as an add-on therapy for treating nightmares.

METHODS

Thirty-two subjects having nightmares (ICD-10: F51.5) at least twice a week participated. Subjects were randomly assigned to group: A) Gestalt therapy group (= GTG), or B) Gestalt and lucid dreaming group therapy (= LDG). Each group lasted ten weeks. Participants kept a sleep/dream diary over the treatment. Examinations with respect to nightmare frequency and sleep quality (Pittsburgh Sleep Quality Index) were carried out at the beginning, after five and ten weeks and at a follow-up three months later.

RESULTS

Concerning nightmare frequency, a significant reduction was found in both groups after the ten-week-study and at the follow-up (Wilcoxon test: P ≤ 0.05). Significant reduction in dream recall frequency could only be observed in the GTG (Wilcoxon test: P ≤ 0.05). For subjects having succeeded in learning lucid dreaming, reduction was sooner and higher. Sleep quality improved for both groups at the follow-up (P ≤ 0.05, Wilcoxon test). Only the LDG showed significant improvement at the end of therapy (P ≤ 0.05).

CONCLUSION

Lucid dreaming, in combination with Gestalt therapy, is a potent technique to reduce nightmare frequency and improve the subjective quality of sleep.

Randomized controlled trials of psychological and pharmacological treatments for nightmares: a meta-analysis

A meta-analysis of treatments for nightmares is reported. The studies were identified by database searches and by an inspection of relevant reference lists. The inclusion criteria were: nightmares as a target problem, studies published in English, use of a randomized controlled trials and reporting of nightmare-relevant outcomes. A total of 19 studies, published between 1978 and 2012 were identified, which included 1285 participants. Effect sizes were calculated as Cohen's d. A statistically significant improvement for all studies combined (d = 0.47, 95% CI = 0.33-0.60, fixed effects model; d = 0.49, 95% CI = 0.32-0.66, random effects model) and for psychological treatments alone (d = 0.48, 95% CI = 0.36-0.60, random) and for prazosin alone (d = 0.50, 95% CI = 0.03-0.96, random) was found. Individual therapy format yielded a higher effect size than a self-help format (p = 0.03). Minimal interventions (relaxation, recording) yielded lower overall effect size than studies offering more extensive interventions (p = 0.02). It is concluded that there are both psychological and pharmacological interventions which have documented effects for the treatment of nightmares.

Assessing metacognitive skills in waking and sleep: a psychometric analysis of the Metacognitive, Affective, Cognitive Experience (MACE) questionnaire

The Metacognitive, Affective, Cognitive Experience (MACE) questionnaire was designed to assess metacognition across sleep and waking (Kahan & LaBerge, 1996). The present research evaluates the psychometric properties of the MACE. Data from two recent studies (N=185) were used to assess the inter-item consistency, test-retest reliability, and factorial, convergent, and discriminant validity of the MACE. Results show that the MACE is a reliable measure with good construct validity. Exploratory factor analyses revealed one self-regulation and two monitoring factors. One monitoring factor emphasized monitoring internal conditions; the other emphasized monitoring external conditions. This factor structure is consistent with the Metacognitive Model (Nelson & Narens, 1990). Tests of convergent and discriminant validity suggest that the MACE is assessing metacognition and is appropriately related to similar constructs such as mindfulness and self-consciousness. The implication of these findings as well as suggestions for research and clinical applications of the MACE are discussed.

Frequency of Lucid Dreaming in a Representative German Sample

Lucid dreams occur when a person is aware that he is dreaming while he is dreaming. In a representative sample of German adults ( N = 919), 51% of the participants reported that they had experienced a lucid dream at least once. Lucid dream recall was significantly higher in women and negatively correlated with age. However, these effects might be explained by the frequency of dream recall, as there was a correlation of .57 between frequency of dream recall and frequency of lucid dreams. Other sociodemographic variables like education, marital status, or monthly income were not related to lucid dream frequency. Given the relatively high prevalence of lucid dreaming reported in the present study, research on lucid dreams might be pursued in the sleep laboratory to expand the knowledge about sleep, dreaming, and consciousness processes in general.

Nightmare frequency and nightmare topics in a representative German sample

Nightmares are defined as disturbing mental experiences that generally occur during REM sleep and often result in awakening. Whereas the number of publications addressing nightmare frequency and psychopathology, nightmare etiology and treatment is increasing rapidly in the last few years, nightmare content has been studied very rarely in a systematic way, especially in adults. The present study investigated nightmare frequency and the frequency of various nightmare topics in a representative German sample. The five most common themes were falling, being chased, paralyzed, being late, and the deaths of close persons. Even though several effects can be explained by the continuity hypothesis of dreaming, further research is needed to investigate the possible metaphoric relationship between nightmare topics like falling or being chased and waking-life stressors.

Recall Frequency of Positive and Negative Dreams in a Representative German Sample

The effects of sociodemographic variables on dream recall frequencies were investigated in a representative sample. Analysis indicated that age, sex, social class, and the size of the place of residence showed small but significant effects on the frequency of positively toned and neutral dreams. Women and inhabitants of large cities tended to report dreams more often than men and residents of small towns. There was also a decline in dream-recall frequency across age groups. The statistical analysis for the recall frequency of negatively toned dreams which were recalled less often showed less pronounced effects.

Dream recall frequency in a representative German sample

The present study investigated the effects of sociodemographic variables on dream recall frequencies in a representative sample of 931 persons over 14 years of age. Analyses indicated that age, sex, and the size of the place of residence had small but significant effects: women and inhabitants of large cities tend to report dreams more often than men and residents of small towns. There was also a decline in dream-recall frequency with age. The explained variance, however, was small.

Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature?

Sleep disturbances are often viewed as a secondary symptom of post-traumatic stress disorder (PTSD), thought to resolve once PTSD has been treated. Specific screening, diagnosis and treatment of sleep disturbances is therefore not commonly conducted in trauma centres. However, recent evidence shows that this view and consequent practices are as much unhelpful as incorrect. Several sleep disorders-nightmares, insomnia, sleep apnoea and periodic limb movements-are highly prevalent in PTSD, and several studies found disturbed sleep to be a risk factor for the subsequent development of PTSD. Moreover, sleep disturbances are a frequent residual complaint after successful PTSD treatment: a finding that applies both to psychological and pharmacological treatment. In contrast, treatment focusing on sleep does alleviate both sleep disturbances and PTSD symptom severity. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be a core feature. Sleep-focused treatment can be incorporated into any standard PTSD treatment, and PTSD research needs to start including validated sleep measurements in longitudinal epidemiologic and treatment outcome studies. Further clinical and research implications are discussed, and possible mechanisms for the role of disturbed (REM) sleep in PTSD are described.

Gender differences in dream recall: a meta-analysis

Many studies have reported gender differences in dream recall. Data from 175 independent studies have been included in the analyses. Overall, estimated effect sizes in five age groups of healthy persons differed significantly from zero. Variables like measurement method and publication year did not affect the gender difference but age groups showed different effect sizes. The smallest effect size was found for children (0.097), the largest for adolescents (0.364), whereas the three adult groups ranged from 0.242 to 0.270. The findings suggest that the age-dependent gender differences in dream recall might be explained by gender-specific 'dream socialization'. Longitudinal studies in this area, however, are still lacking.

Dreaming in posttraumatic stress disorder: A critical review of phenomenology, psychophysiology and treatment

This review summarizes the available knowledge on the phenomenology of posttraumatic dreams. Posttraumatic nightmares are reported by up to 70% of individuals suffering from posttraumatic stress disorder (PTSD). An extensive review of polysomnographic studies suggests that neither this high incidence nor the occurrence of posttraumatic nightmares throughout the sleep cycle can be explained by altered REM sleep parameters. The assumption that a reduction of dream recall may serve as a coping mechanism in PTSD patients is questionable. About 50% of posttraumatic dreams comprise exact replications of the traumatic events. Therefore dreams in PTSD do not have stereotypical content. Data characterizing non-replicative posttraumatic dreams and indicating a change in dream content over time must be considered preliminary. Occurrence of posttraumatic dreams is associated with psychopathological developments. Imagery Rehearsal Therapy has repeatedly been proven to be a valuable tool in treating patients suffering from posttraumatic dream disturbance. A deeper knowledge of posttraumatic dreams is essential for any theory of PTSD as well as for a better understanding of the overall function of dreaming.

Lucid dreaming treatment for nightmares: a pilot study

BACKGROUND

The goal of this pilot study was to evaluate the effects of the cognitive-restructuring technique 'lucid dreaming treatment' (LDT) on chronic nightmares. Becoming lucid (realizing that one is dreaming) during a nightmare allows one to alter the nightmare storyline during the nightmare itself.

METHODS

After having filled out a sleep and a posttraumatic stress disorder questionnaire, 23 nightmare sufferers were randomly divided into 3 groups; 8 participants received one 2-hour individual LDT session, 8 participants received one 2-hour group LDT session, and 7 participants were placed on the waiting list. LDT consisted of exposure, mastery, and lucidity exercises. Participants filled out the same questionnaires 12 weeks after the intervention (follow-up).

RESULTS

At follow-up the nightmare frequency of both treatment groups had decreased. There were no significant changes in sleep quality and posttraumatic stress disorder symptom severity. Lucidity was not necessary for a reduction in nightmare frequency.

CONCLUSIONS

LDT seems effective in reducing nightmare frequency, although the primary therapeutic component (i.e. exposure, mastery, or lucidity) remains unclear.

Costly Signaling Theory of REM Sleep and Dreams

The function of REM sleep dreaming is still unknown. We situate our approach to understanding dream phenomenology and dream function within that part of evolutionary theory known as Costly Signaling Theory (CST). We contend that many of the signals produced by the dreaming brain can be and should be construed as “costly signals”—emotions or mental simulations that produce daytime behavioral dispositions that are costly to the dreamer. For example, often the dreamer will appear in the dream as handicapped in some way (i.e., no clothes, no ID, no money, is under attack, being chased etc.). The dreamer, during waking life, is then influenced by the carry-over effect of the unpleasant dream content. The informational and affective content of the dream creates a mental set in the dreamer that operates during the daytime to facilitate the signaling of a “handicapped” Self. The subtle signaling effect might be via display of the intense emotions or physical demeanor that had first appeared in the dream. When the dreamer shares his dream with others the dream has a more direct impact on waking life and social interactions. In effect, the dreamer uses his or her dreams to adopt a self-handicapping strategy when dealing with significant others. The increased use of costly signals (the self-handicapping strategy) during the daytime then facilitates some vital communicative goal of the dreamer.

Clinical management of chronic nightmares: imagery rehearsal therapy

Problems with nightmares are reported by a sizable proportion of individuals with a history of trauma and by approximately 5% to 8% of the general population. Chronic nightmares may represent a primary sleep disorder rather than a symptom of a psychiatric disorder, and direct targeting of nightmares is a feasible clinical approach to the problem. Of the treatments proposed, imagery rehearsal therapy (IRT) has received the most empirical support. An up-to-date account of this cognitive-imagery approach shows how to treat nightmares during 4 roughly 2-hr sessions. The main points covered in each therapy session and their underlying rationale are presented. Dismantling protocols are suggested to discern active ingredients of IRT and to develop flexible applications based on patients' needs.

Nightmares: from anxiety symptom to sleep disorder

The DSM-IV-TR definition of nightmares-extremely frightening dreams from which the person wakes up directly-is unnecessarily narrow. Other emotions (anger, grief) have also been reported in nightmares, and direct awakening from a bad dream seems to be unrelated to increased distress. In addition, assessment of nightmares is problematic. Polysomnographic recordings have an ameliorating effect on nightmare frequency, retrospective measurements tend to underestimate nightmare frequency, and persons with frequent nightmares may feel reluctant to fill out (daily) prospective measurements. For studying nightmares, it is necessary to distinguish idiopathic nightmares from posttraumatic nightmares, which are part of a posttraumatic stress reaction or disorder that may result from experiencing a traumatic event. Both types of nightmares have been associated with an elevated level of periodic limb movements, although only posttraumatic nightmares seem to be related to more and longer nocturnal awakenings. Nightmares have also been repeatedly associated with the general level of psychopathology, or the so-called personality factor neuroticism. Nightmare distress, the impact on daily functioning caused by nightmares, may function as a mediating variable. Several studies in the last decades have shown that nightmares can be treated with several cognitive-behavioral techniques. The cognitive-restructuring technique imagery rehearsal therapy is the treatment of choice for nightmares, although a randomized controlled trial with an attention control-group has not yet been carried out. Nightmares are more than a symptom of a larger (anxiety) syndrome and need to be viewed from a sleep medicine perspective: nightmares are a highly prevalent and separate sleep disorder that can and should receive specific treatment.

Nightmares: personality dimensions and psychopathological attributes

In this article, in an attempt to integrate recent findings with existing knowledge, we provide an overview of issues related to nightmares that could be useful as a guide to clinical work. After defining what should be considered as a nightmare, we look into the relationship of nightmares with issues such as normal development and maturation, as well as culture. Issues of stress and personality are then discussed in their relation to situational and chronic nightmares. State and trait factors are further elaborated on as we explore the relationship of nightmares and psychopathology. A brief review of organic and pharmacological causes of nightmares follows before we embark on a discussion of issues that relate nightmares to psychological trauma. Some final remarks on treatment conclude our review.

Do people still report dreaming in black and white? An attempt to replicate a questionnaire from 1942

In the 1940s and 1950s many people in the United States appear to have thought they dreamed in black and white. For example, Middleton (1942) found that 70.7% of 277 college sophomores reported "rarely" or "never" seeing colors in their dreams. The present study replicated Middleton's questionnaire and found that a sample of 124 students in 2001 reported a significantly greater rate of colored dreaming than the earlier sample, with only 17.7% saying that they "rarely" or "never" see colors in their dreams. Assuming that dreams themselves have not changed over this time period, it appears that one or the other (or both) groups of respondents must be profoundly mistaken about a basic feature of their dream experiences.