Posttrauma Nightmares Research Articles

Testing the nightmare cognitive arousal processing model.

Posttrauma nightmares are recurring nightmares that begin after a traumatic experience. Research has only recently begun to identify variables that predict posttrauma nightmare occurrences. Research has identified presleep arousal-cognitive (PSA-C) and presleep arousal physiological (PSA-PHYS), sleep onset latency (SOL), and sleep-disordered breathing (SDB) as potential predictors of posttrauma nightmares. However, previous research includes methodological limitations, such as a lack of physiological measures and a homogeneous sample. To replicate previous findings and increase generalizability, the current study investigated predictors of nightmare occurrences in a sample of male inpatient veterans with mixed-trauma history. Participants (n = 15) completed an initial assessment battery and seven consecutive days of pre and postsleep diaries, including measures of posttrauma nightmare triggers and posttrauma nightmare occurrences. Portable objective measurements of sleep and presleep states were used to examine sleep quality and physical arousal. Analyses revealed that PSA-C and SOL both predicted posttrauma nightmare occurrences and that PSA-PHYS was significantly higher on nights when nightmares occurred. Results replicate earlier research which posits that PSA and SOL play a role in triggering the occurrence of posttrauma nightmares. It should be noted that the sample was relatively small, warranting cautious interpretation of results. However, when taken together with the findings of the replicated study, results could suggest the plausibility of therapies targeting presleep cognitions, SOL, and presleep arousal in the treatment of posttrauma nightmares. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

0677 Impact of Cognitive Behavioral Therapy for Post-trauma Nightmares on Sleep-efficiency: Examining Data on Sleep Diary Data

Abstract Introduction Prior research has not examined the impact of cognitive behavioral therapy (CBT) for post-trauma nightmares on aspects of sleep quality as measured by sleep diary data. While self-report measures assessing sleep quality have demonstrated that CBT for post-trauma nightmares is associated with significant improvements in sleep quality pre- to post-treatment, it is important to specifically analyze changes using sleep diary data given that research has demonstrated large discrepancies in self-report measures of sleep behavior and prospective sleep diary data. Methods All participants in this study were recruited from the local community as part of ongoing clinical trials studying the efficacy of Exposure, Relaxation, Rescription Therapy (ERRT). Each individual reported a history of a criterion A trauma and at least one nightmare weekly. Sleep diary data was collected at each weekly treatment session and included questions regarding time in bed, sleep-onset latency, time out of bed, wake time after sleep onset so that variables of total sleep time, time in bed, and sleep efficiency could be calculated. Participants were instructed to complete the sleep diary each morning while in treatment. Only participants who completed the full ERRT protocol were included. Results Results from 93 individuals were analyzed with a dependent samples t-test. The mean sleep efficacy prior to treatment was .85 (SD = .14) and after treatment was .92 (SD = .07), resulting in a t-value of 3.00 (p < .01; Cohen’s d = .57; 95% CI .16 -.96). Conclusion Results show that there is a significant and meaningful change in sleep efficiency from pre- to post-treatment of a form of CBT for post-trauma nightmares. Given that ERRT does not directly target time in bed or utilize sleep restriction, this is notable that it is associated with such improvements in sleep directly related to time spent in bed. As some research has suggested that aspects of CBT for insomnia may need to be combined with treatment for nightmares to successfully treat trauma-related sleep disturbances, these results indicate that CBT for nightmares alone may be sufficient. Limitations and future directions will be discussed. Support (If Any)

Does Nightmare Rescription Lead to Meaningful Changes in Language Use? An Investigation within a Treatment Seeking Sample with Chronic Post-Trauma Nightmares

Given language's significant relationship to underlying psychological functioning, studying changes in language use regarding post-trauma nightmare (PTNM) content throughout a rescription-based treatment can offer insight into the nature of change in language associated with such treatments. LIWC2015 is an efficient tool that analyzes bodies of text for words that are theoretically representative of verbal and written expressions of underlying emotional and cognitive processes. LIWC2015 has not been extensively studied with PTNMs. The current study analyzed changes in language across cognitive and emotional domains using LIWC in a trauma-exposed treatment-seeking sample. Our analyses revealed significant changes in the frequency of words related to emotions and cognitive processing from the nightmare to rescription. In general, the rescripted imagery, relative to the nightmare, contained significantly fewer words pertaining to cognitive processing and negative emotions. This is the first known study to examine the change in language use, via word count, between nightmares and their rescripted versions. As language use is strongly associated with psychological health, these findings have clinical implications for providers and clients alike.

Assessing Triggers of Posttrauma Nightmares.

Posttrauma nightmares are recurring nightmares that begin after a traumatic experience and can occur as often as multiple times per week, often in a seemingly random pattern. Although these nightmares are prevalent in trauma survivors, little is known about the mechanisms underlying their sporadic occurrence. The present study aimed to investigate predictors of posttrauma nightmares. The sample included 146 observations nested within 27 female college students who reported frequent nightmares related to sexual trauma. Participants were recruited from an undergraduate student subject pool (n = 71) or were clinical referrals (n = 75). Participants completed an initial assessment battery and six consecutive days of pre- and postsleep diaries, which included measures of potential posttrauma nightmare triggers and measures intended to assess sleep quality and posttrauma nightmare occurrence. Descriptive statistics, mean comparisons, and multilevel modeling were used to examine the data. The results showed that both presleep cognitive arousal, γ10 SLij = 0.58, p = .006, z(1, N = 146) = -2.61; and sleep latency (SL), γ20 PCAij = 0.76, p < .001, z(1, N = 146) = -2.69, predicted posttrauma nightmare occurrence. Further investigation suggested that presleep cognitive arousal moderated the relation between SL and posttrauma nightmare occurrence, γ30 PCA x SLij = 0.67, p = .048 z(1, N = 146) = 1.98. The present results are the first to show that the co-occurrence of presleep arousal and delayed sleep onset latency may influence posttrauma nightmare occurrence, suggesting that the time immediately before sleep is crucial to the production of the posttrauma nightmares.

0801 Sleep, Nightmares, and the Maintenance of Posttrauma Symptoms

Abstract Introduction Most individuals will experience at least one traumatic event in their lifetime. Although most individuals who experience a trauma will exhibit some posttrauma symptoms, only a small subset will experience long-lasting symptoms. In fact, most research suggests that posttrauma symptoms will gradually reduce over time. However, some individuals can exhibit posttrauma symptoms for an extended period of time. Although research has demonstrated that poor overall sleep quality may explain why some people have trouble gradually recovering from posttrauma symptoms, research has yet to examine specific aspects of sleep that can impair the gradual remission of posttrauma symptoms. This study examined how individual facets of sleep quality (such as nightmares and sleep duration) impact posttrauma symptoms over time. Methods 944 college students completed an online survey battery that included measures of traumatic experiences, time since trauma (TST), posttrauma symptoms, sleep quality, and the presence of nightmares. Regression analyses were used to examine the interaction of sleep quality sub-facets and time since trauma on posttrauma nightmares (PNMs). Results Out of 944 participants, 637 (67%) reported at least one trauma. Of those students, time since trauma (TST) and all other sleep variables significantly predicted posttrauma symptoms (p &amp;lt; 0.05). However, the only significant interaction was nightmares and TST (p &amp;lt; 0.01) where individuals who experienced PNMs had significantly (p &amp;lt; 0.01) higher posttrauma symptom intercept (48.19) than individuals who did not experience PNMs (31.19). Furthermore, individuals who experienced PNMs demonstrated statistically significant flatter slopes than those without nightmares (p &amp;lt; 0.01). Conclusion The results reveal that time since trauma predicts a decrease in posttrauma symptoms, whereas nightmares impede this symptom reduction. Interestingly, the interaction finding suggests that nightmares play a critical role in initial symptom expression and recovery. These results demonstrate the importance of identifying and treating nightmares immediately following a trauma. Support “none”

1070 An Examination of the Relationship Between Language Use in Post-Trauma Nightmares and Psychological Sequelae in a Treatment Seeking Population

Abstract Introduction Studying language use in dreams and nightmares has become an increasingly used tool to understand underlying emotional and cognitive processes. Specifically, in regards to post-trauma nightmares (PTNMs), nightmare transcriptions can offer a lens to understand a survivor’s interpretation of their trauma. The current study will utilize a method of quantitative text analysis to analyze the relationship between specific psychological constructs and symptoms of posttraumatic stress disorder (PTSD) and nightmare qualities. It is hypothesized that there will be a positive correlation between words related to perceptual processes and negative emotions in nightmares and PTSD symptom and nightmare severity. There will be a negative correlation between cognitive processes and positive emotion words, and PTSD symptom and nightmare severity. Methods Fifty-three nightmares were collected from participants that were recruited from the community in a Midwestern city as part of an ongoing investigation of the effectiveness of a brief cognitive-behavioral intervention for PTNM, Exposure, Relaxation, and Rescripting Therapy (ERRT). All participants were over the age of 18, have experienced a criterion A trauma, and have nightmares at least once weekly. Linguistic Inquiry and Word Count (LIWC) was utilized to analyze the nightmare transcriptions. The Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Trauma-related Nightmare Survey (TRNS) were used to measure symptom severity. A Pearson’s correlation analysis was used for this exploratory study. Results Words related to perceptual processes were significantly positively correlated with PTSD symptom and nightmare severity (p&amp;lt;.05) Neither negative nor positive emotion words were significantly related to PTSD and nightmare symptoms (p&amp;gt;.05). Cognitive processing words were significantly negatively correlated with PTSD and nightmare symptoms (p&amp;lt;.05). Conclusion The results of this study support the hypothesis that language use in nightmares reveals important information about underlying cognitive and emotional functioning. The results of this study may have an important impact on treatment considerations for those who have experienced trauma. Analyzing language use in PTNM may help to understand the etiology and maintenance of PTSD symptoms. Support Support for this study comes from the University of Tulsa Institute of Trauma, Adversity, and Injustice.

1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence?

Abstract Introduction The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content. Methods Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests. Results Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p &amp;lt; 0.001). Conclusion Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course. Support None.

Treating post-trauma nightmares and posttraumatic stress disorder in an individual with psychosis

Post-trauma nightmares often persist, even following intervention for posttraumatic stress disorder (PTSD) (Davis, DeArellano, Falsetti, & Resnick, 2003;Scurfield, Kenderdine, & Pollard, 1990). Research finds that directly targeting post-trauma nightmares is effective in reducing their frequency and severity, as well as improving related symptoms (Augedal, Hansen, Kronhaug, Harvey, & Pallesen, 2013; Casement & Swanson, 2012; Ho, Chan, & Tang, 2016; Krippner & Taitz, 2017; Rousseau & Belleville, 2018). Most efforts exploring the efficacy of interventions for post-trauma nightmares have not been evaluated in individuals with psychosis. However, recent research suggests that individuals with psychosis experience frequent nightmares and comorbidity with traumatic stress disorders (Sheaves, Onwumere, Keen, Stahl, & Kuipers, 2015). The current study evaluated the efficacy of a combination of two treatments, Exposure, Relaxation, and Rescripting Therapy (Davis, 2009) and Cognitive Processing Therapy (Resick, Monson, & Chard, 2017), for an individual with visual and tactile hallucinations, nightmares, and PTSD. Results indicated that the participant tolerated all treatment aspects, including written exposure to the content of the post-trauma nightmares. Further, the combined treatment resulted in improvement in trauma-related nightmare frequency and severity, PTSD symptoms, negative posttraumatic cognitions, depressive symptoms, and sleep quality and quantity. Findings suggested that individuals with frequent nightmares, PTSD, and psychosis may benefit from direct treatments targeting these conditions.

A quantitative text analysis approach to describing posttrauma nightmares in a treatment-seeking population.

A quantitative text analysis approach to describing posttrauma nightmares in a treatment-seeking population.

The impact of exposure, relaxation, and rescripting therapy for post-trauma nightmares on suicidal ideation.

This study investigated whether a brief psychotherapy for post-trauma nightmares (exposure, relaxation, and rescripting therapy [ERRT]), reduced suicidal ideation (SI). We hypothesized that: (a) nightmare frequency and severity, post-traumatic stress disorder (PTSD), depression, and sleep quality would be related to SI at pretreatment; (b) SI would decrease from pre- to post-treatment; and (c) the decrease in SI would remain after controlling for change in PTSD and depression. Seventy-five individuals exposed to a traumatic event and who experienced frequent nightmares (minimum one per week) participated in ERRT. Participants were not required to have a psychological diagnosis. Thirty percent endorsed SI at pretreatment. Depression and PTSD were related to SI at pretreatment. SI decreased following treatment; however, the third hypothesis was not supported. Results suggest brief psychotherapy targeting post-trauma nightmares may decrease SI. More research is necessary to determine what factors contribute to decreases in SI.

Dreamwork

My passion for dreamwork arose from discovering the power of dreams as a multi-level spiritual process within me and others in 1985 when I joined a group of therapists meeting regularly to explore our dreams. For several years we laughed and cried together as we discovered new insights, challenges, affirmations, and healing. I was inspired by a “big dream” of my own about embarking on a journey of the soul. I studied to learn more about dreams and began leading workshops, seeing with awe how dreams opened windows into everyone’s inner experience, from post-trauma nightmares to perceptive feedback on personal issues to unforgettable mystical visions. I learned to ask simple questions of dreamers and I take continuing delight in seeing the “Aha” in the eyes of clients, students, and colleagues as they make connections and discover new perspectives. From the beginning of psychotherapy, dreamwork in one form or another has been of its essence.&#x0D; Waitara&#x0D; I pupū ake taku ngākaunui ki te whakarehu i te kitenga i te awe o te moemoeā pēnei ki tētahi paparanga hātepe wairua i roto i a au me ētahi atu, i te tau 1985, i tōku piringa ki tētahi rōpū kaihaumanu tūtakitaki ai ki te hōpara i ā mātou moemoeā. He maha ngā tau kata tahi, tangi tahi ai mātou ia wā kitea he tirohanga hou, he takinga, he whakakoihanga, he tumahuhanga. Whakahiringa ngākauhia ahau i tētahi pekerangi nui āku. Ka whakawhānuihia ake e au aku akoranga mō tēnei mea te moemoeā ka tīmata ki te taki awheawhe me te kite kaiora i te mahi a te moemoeā ki te whakatuwhera huarahi wheako whakaroto o te katoa, mai i ngā kuku i muri pāmamae ki ngā whakautu hōhonu whakapā ki ngā take whearo ki ngā kitenga māminga. I mōhio au kia noho mahuki ngā pātai, ā, e haere tonu ana te harikoa ki te kite i te taka o te māramatanga ki ngā kanohi o ngā kiritaki, ākonga me ngā hoamahi ia wā puta mai ngā hononga me ngā kitenga hou. Mai i te tīmatanga o te whakaoranga hinengaro, ko te whakarehu me ōna āhua tōna iho.

Taking Control: Examining the Influence of Locus of Control on the Treatment of Nightmares and Sleep Impairment in Veterans

Trauma exposure has been linked to external locus of control (E-LOC). This feeling of uncontrollability may be maintained after the trauma by recurring posttrauma nightmares. The present study utilized data from a larger trial, with 19 U.S. veterans, examining the efficacy of a modified version of treatment for nightmares, to examine changes in locus of control in relation to improvements in symptomatology following treatment. Following treatment, internal control beliefs about sleep and nightmares significantly increased, while general control beliefs did not change. Preliminary evidence that exposure, relaxation, and rescripting therapy for military personnel (ERRT-M) is associated with increased sense of control over sleep and nightmares was observed.

A comparison of lifelong and posttrauma nightmares in a civilian trauma sample: Nightmare characteristics, psychopathology, and treatment outcome.

Nightmares and sleep disturbances are thought to play a key role in the development of posttrauma problems. Research efforts have increased in an attempt to understand this association. The present study examined differences in nightmare characteristics, related psychopathology, treatment outcome, and trauma history among trauma-exposed individuals whose nightmares began before a traumatic event and those whose nightmares began after a traumatic event, while controlling for posttraumatic stress disorder status. Individuals whose nightmares began following a trauma experienced more depression and posttraumatic stress symptoms and poorer sleep quality, reported a higher number of traumatic events, and were more likely to report nightmares replicative of or similar to the trauma than those whose nightmares began before the trauma. No other between-groups differences were found for nightmare characteristics or response to treatment. This study is an important step in understanding the nature of nightmares and their relationship to traumatic events and consequences, but additional research is warranted.

Idiopathic and Posttrauma Nightmares in a Clinical Sample of Children and Adolescents: Characteristics and Related Pathology

Nightmares occur commonly during childhood and adolescence as a part of normal childhood development and in response to a traumatic event. Although nightmares are known to be associated with psychological distress, few studies have examined potential differences between idiopathic nightmare sufferers and those whose nightmares began after exposure to a traumatic event (posttrauma). The present study examined such differences in 47 trauma-exposed children and adolescents attending an outpatient treatment facility. It was hypothesized that individuals with posttrauma nightmares would have increased posttraumatic stress disorder symptoms, anxiety, depression, and decreased sleep quality versus those with idiopathic nightmares or no nightmares. Results found that, in general, nightmares are associated with increased distress and impairment, and those with posttrauma nightmares fared worse on several measures of distress than those with idiopathic nightmares or no nightmares. Implications of the current study and suggestions for future research are discussed.

Dream Work Treatment of Nightmares Using Transactional Analysis

Little attention has been given to dreamwork in the transactional analysis literature, yet dreams can be powerful symbolic statements of a client's emotional processes and can serve as clear indicators of the direction psychotherapy might usefully take. This is particularly true of nightmares, which can be seen as the psyche's equivalent to physical pain in the body. Nightmares are often rooted in historical trauma, neglect, or abuse, compounded by Child survival decisions, but they also arise directly out of traumatic experience in adult life. This article contends that combining transactional analysis and simple action methods adapted from psychodrama can be effective in empowering clients to make redecisions; to break the cycle of rackets, games, and script beliefs; and to reduce repetitive posttrauma nightmares. The transactional analysis literature on dreams is briefly reviewed, and several nightmares are described using transactional analysis concepts and a practical dreamwork process. Connections are made to Berne's (1947/1971) concept of physis and James's (James & James, 1992) concept of the inner core.