Description: You can probably recall a time when you had a nightmare, a really bad dream that woke you up, was unsettling and that made it hard for you to get back to sleep. I apologize if re-awakening that memory has re-unsettled you, I am sure it will pass and not continue to bother you. However, what if you are being startled awake by nightmares 3 or more times a week? If so, it might help you to know that there is a DSM-5 diagnostic category called Nightmare disorder or Dream Anxiety disorder. Think about what its diagnostic criteria might include. Now, simply having a name or label for something may not help much but at least it provides a name for the condition and holds out hope that there may be something you can do or get help doing that will reduce or eliminate your symptoms (your nightmares). What might a treatment for nightmare disorder involve? From a clinical perspective, a first step would be to investigate to see if there are things going on in the life of the persons having the nightmares that could be causing or contributing to them. If they are in an abusive relationship, if they or a loved one is struggling with a serious illness or condition, if they are living in a high crime or war zone, or if their job or their housing is precarious then helping them to reduce or stop their nightmares will clearly require efforts to address their life situation. Aside from this, what sort of non-drug-based approach to treatment might help? Think about what a treatment for recurrent nightmares might involve and then read the article linked below for an overview of the DSM-5 diagnostic criteria for nightmare disorder and of a treatment approach that has been shown to be effective (admittedly in a small sample) in reducing or eliminating the incidence of nightmares AND, in some cases, in increasing the frequency of positive dreams.

Source: A new treatment for debilitating nightmares offers sweeter dreams, Jackie Rocheleau, Science News.

Date: October 27, 2022

Image by Mysticsartdesign from Pixabay

Article Link: https://www.sciencenews.org/article/treatment-nightmares-sleep

The linked article describes the efforts of the researchers to develop, tryout and then set up to more generally prove out an approach to treatment of nightmare disorder. The proposed treatment is based on a basin learning model where a re-worked version of their nightmare plot lines are rehearsed during waking hours and paired with a musical chord. The chord was then played while the participants were asleep with the hypothesis that it would support the more positive dream plot line. A control group was included to ensure that the chord alone (when paired with dream unrelated learning) was not producing positive effects. The results are very encouraging, with the dream plot adjustment group showing a significant reduction or even elimination of their nightmares. The researchers diligently point out that more, larger samples, research is needed to test the generalizability of this small sample study. As importantly, the researchers note that a likely means through which this treatment could be made more widely available through the use of commercially available, wrist worn, sleep trackers like Fitbit is problematic due to the fact that such devices do not identify REM sleep patterns as accurately as do brain-monitoring tools. Still, an encouraging start.

Questions for Discussion:

1. What sorts of things distinguish nightmare disorder from “plain old” nightmares?
2. What steps should clinicians take before beginning a psychological treatment approach with people presenting with recurrent nightmares?
3. Why are generalization studies and the assessment of “home delivery” tool important in the development of treatment approaches like those described in the linked article?

References (Read Further):

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

Fleming, K. (2022) Nightmare Disorder DSM-5, 307.47. Link

Standards of Practice Committee, Aurora, R. N., Zak, R. S., Auerbach, S. H., Casey, K. R., Chowdhuri, S., … & Morgenthaler, T. I. (2010). Best practice guide for the treatment of nightmare disorder in adults. Journal of clinical sleep medicine, 6(4), 389-401. Link

Gieselmann, A., Ait Aoudia, M., Carr, M., Germain, A., Gorzka, R., Holzinger, B., … & Pietrowsky, R. (2019). Aetiology and treatment of nightmare disorder: State of the art and future perspectives. Journal of sleep research, 28(4), e12820. Link

Nadorff, M. R., Lambdin, K. K., & Germain, A. (2014). Pharmacological and non-pharmacological treatments for nightmare disorder. International Review of Psychiatry, 26(2), 225-236. Link

Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., … & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041-1055. Link