Abstract
About 80% of posttraumatic stress disorder (PTSD) patients suffer from nightmares or dysphoric dreams that cause major distress and impact nighttime or daytime functioning. Lucid dreaming (LD) is a learnable and effective strategy to cope with nightmares and has positive effects on other sleep variables. In LDs, the dreamer is aware of the dreaming state and able to control the dream content. The aim of this study is to evaluate the effectiveness of lucid dreaming therapy (LDT) in patients suffering from PTSD. We suggest that learning a technique that enables the affected subjects to regulate the occurrence and content of nightmares autonomously increases the chance of coping with the complex symptoms of PTSD and can reduce suffering. Sleep quality (PSQI, Pittsburgh Sleep Quality Index), daytime sleepiness (ESS, Epworth Sleepiness Scale), quality of life (MQLI, Multicultural Quality of Life Index), psychological distress (SCL-90-R, Symptom Checklist 90-Revised), distress caused by traumatic events (IE-S, Impact of Events Scale), anxiety (SAS, Self-Rating Anxiety Scale), depression (SDS, Self-Rating Depression Scale), and nightmare severity were assessed in a self-rating questionnaire before and after the intervention. LDT had no effect on the investigated sleep variables. No correlation between reduction of nightmare severity and changes in PTSD-profile (IE-S) was found. Nevertheless, levels of anxiety and depression decreased significantly in the course of therapy. LDT could provide an alternate or complementary treatment option for nightmares in PTSD, specifically for symptoms of anxiety and depression.
Highlights
Nightmares are vivid dream experiences loaded with anxiety or fear, which typically occur during rapid eye movement (REM) sleep and less commonly during N2 sleep (American Academy of Sleep Medicine, 2014)
Minimal diagnostic criteria are as follows: (1) the patient suffers from repeated episodes of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity; (2) on awakening from the dysphoric dreams, the person rapidly becomes oriented and alert; and (3) the dream experience itself or the sleep disorder resulting from it causes significant distress or impairment in social, occupational, or other important areas of functioning
No hypotheses confirmation on the effectiveness of lucid dreaming therapy (LDT) could be found
Summary
Nightmares are vivid dream experiences loaded with anxiety or fear, which typically occur during rapid eye movement (REM) sleep and less commonly during N2 sleep (American Academy of Sleep Medicine, 2014). Common themes include failure and helplessness, physical aggression, accidents, being chased, health-related concerns and death, and interpersonal conflicts (Robert and Zadra, 2014; Schredl and Göritz, 2018). If these dysphoric dreams recur with enough frequency, cause major distress and impact nighttime or daytime functioning, they may be classified as nightmare disorder (American Academy of Sleep Medicine, 2014). Nightmare distress can lead to problems at work, social and cognitive impairments and was even associated with a higher suicide risk (Nadorff et al, 2018)
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