No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review
Abstract
Objectives:
Nightmares can be defined as "an unpleasant dream with anxiety and oppression". They represent a symptom possibly leading to serious psychiatric and physical consequences. It occurs to 2% to 8% of the general population. Lucid dreaming therapy (LDT) is an interesting upcoming psychotherapy for the treatment of nightmares. The aim of this study was to evaluate the efficacy of LDT in the treatment of nightmares in adults and children.
Methods:
We performed a systematic review of the literature, based on the Cochrane organisation's methodology. We explored the PubMed, Cochrane library, PsycINFO via Ovid and Embase databases and clinical trial registries (CTR), namely clinicaltrials.gov, EU clinical trials and the WHO clinical trials registry platform.
Results:
Four randomized controlled trials (RCT), 2 case series and 5 case reports were included. Most of the included studies found LDT effective in reducing nightmare frequency among adults with chronic and recurring nightmares. We did not identify any reports in children.
Conclusions:
Despite a limited internal validity for the included studies, these first results are encouraging. Nonetheless, larger and more rigorous studies would allow to better assess the utility of LDT for nightmares.
... The relevance of this differentiation and its relationship 8 with lucid dreaming will then be analyzed from the viewpoint of two representative brain 9 disorders: schizophrenia, the paradigmatic disease for psychotic hallucinations, and 10 narcolepsy, the paradigmatic disease for hypnagogic/hypnopompic experiences. The 11 distinction between schizophrenia and narcolepsy offers a conceptual framework that will 12 then be discussed for neurodegenerative diseases, and particularly for Lewy body 13 disorders (i.e. Parkinson's disease, Parkinson's disease dementia and dementia with 14 Lewy bodies), where putative hallucinations are likely a mix of genuine psychotic 15 hallucinations (21-23) and non-psychotic hypnagogic/hypnopompic experiences (24- 16 26). ...
... The wordings 11 'hypnagogic hallucinations', 'hypnopompic hallucinations', 'sleep related hallucinations' 12 and similar variants should thus probably be reconsidered. Furthermore, clinical scales 13 currently available to assess hallucinations typically do not include any item for 14 hypnagogic/hypnopompic experiences ( sensitivity and specificity and reducing ambiguity in the literature (hypothesis 2, Table 1). ...
... Sleep paralysis offers an example of how a sense of being awake is not sufficient 11 to infer that one is necessarily awake. In fact, recent polysomnographic findings suggest 12 that during sleep paralysis the brain is not in an awake state, as classically considered, 13 but in a dreaming state (31 To avoid the perceptual misinterpretation of hypnagogic/hypnopompic 8 experiences as hallucinations, it is necessary to introduce a third level of reality testing 9 that is neither sensory nor cognitive, but more broadly metacognitive (27). At this level, 10 the issue is not about discriminating between the external or internal sources of 11 perceptual experiences, but about discriminating the awake or dreaming state in which 12 those experiences occur. ...
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.
... Lucid dreamers predominantly seek pleasure in their lucid dreams (Bonamino, Watling, & Polman, 2024;Schädlich & Erlacher, 2012;. However, LD can also be used for more practical ends, including reducing nightmare frequency and intensity (Ouchene et al., 2023), creative problem-solving (Stumbrys & Daniels, 2010), and practicing waking skills (Bonamino et al., 2023;Peters et al., 2023). LD may also support mental well-being (Wessling, 2023), personal growth (Konkoly & Burke, 2019), and treatment of clinical depression (Sackwild & Stumbrys, 2021). ...
... This is excepted given the association between LD and nightmare frequency (Schredl & Erlacher, 2004). LD as a form of nightmare treatment is common in both young and adult populations (Bonamino, Watling, & Polman, 2024;Schädlich & Erlacher, 2012; and supported by preliminary research (Ouchene et al., 2023). Accordingly, participants in this study reported often successfully overcoming or avoiding nightmares by manipulating the dream events into more pleasant ones or deliberately waking themselves up. ...
In addition to being aware of being in a dream, dreamers in a lucid dream can sometimes also intentionally execute predetermined actions and manipulate the dream’s narrative. These features open the opportunity to use lucid dreaming (LD) as a recreational, therapeutic and skill acquisition tool. This study conducted semistructured interviews with nine adolescent lucid dreamers to gain insight into their LD experiences and the role these play in their waking lives. Reflexive thematic analysis revealed that LD provided participants with a space where they felt safe to explore movements and behaviors without the repercussions they would experience if they were awake. During LD they trained motor skills, addressed emotional conflicts, prepared for difficult waking life situations, and engaged in fun activities. These experiences promoted motor learning, self-efficacy, personal growth, and mental well-being. This study also highlighted that training motor skills in a lucid dream may at times heighten waking self-efficacy but not necessarily motor performance. LD brought participants a sense of freedom, liberation, and empowerment, alongside positive emotions, and a temporary release from the burdens of their waking lives. Advanced dream manipulation skills may not be mandatory for benefiting from LD, suggesting that LD may be a valuable tool for novice lucid dreamers and those with limited dream manipulation. Adolescence is a period marked by self-evaluations and the development of one’s own identity. LD may be a valuable tool to support these developmental processes and adolescents’ well-being.
... For instance, the dreamer might recognize a dangerous situation as a dream, realising it is not as threatening as initially predicted. Due to the ability to update expectations with this newfound understanding of the dreamscape, lucid dreams may offer a way to help individuals suffering from nightmares reduce their frequency and intensity (Ouchene et al., 2023). ...
... If dreams do indeed contribute to trauma through PEs, as argued, it is important to consider how these effects could be mitigated. There is supporting evidence that lucid dreaming therapy may reduce nightmare frequency and intensity (Ouchene et al., 2023). We have previously noted how lucidity and control might help reduce or avoid the PEs related to trauma contributions. ...
It is widely known that dreams can be strongly affected by traumatic events, but there may be other ways in which dreams relate to trauma. In this paper, we argue that different types of dreams could both contribute to trauma and alleviate it according to the prediction errors that occur either in dreams or in response to them after waking. A prediction error occurs when an experience contradicts one’s expectation and it is often accompanied by surprise. Prediction errors are involved in memory updating processes that can be long-lasting. Not only nightmares but also unpleasant, and surprisingly, even neutral and pleasant dreams have the potential to contribute to trauma, affecting our waking lives in a similar way to waking traumatic experiences. We postulate that certain dreams can also be beneficial for trauma alleviation. Further, clinical evidence suggests that working with prediction errors that occurred in dreams and during our response to dreams after waking can assist in alleviating the negative effects of trauma.
... For instance, the dreamer might recognize a dangerous situation as a dream, realising it is not as threatening as initially predicted. Due to the ability to update expectations with this newfound understanding of the dreamscape, lucid dreams may offer a way to help individuals suffering from nightmares reduce their frequency and intensity (Ouchene et al., 2023). ...
... If dreams do indeed contribute to trauma through PEs, as argued, it is important to consider how these effects could be mitigated. There is supporting evidence that lucid dreaming therapy may reduce nightmare frequency and intensity (Ouchene et al., 2023). We have previously noted how lucidity and control might help reduce or avoid the PEs related to trauma contributions. ...
Michelle Maiese: Trauma, dissociation, and relational authenticity
Caroline Christoff: Performative trauma narratives: Imperfect memories and epistemic harms
Aisha Qadoos: Ambiguous loss: A loved one's trauma
Alberto Guerrero Velazquez: El trauma está en la respuesta. Hacia una visión post-causal en la definición de trauma psicológico
Clarita Bonamino, Sophie Boudrias, and Melanie Rosen: Dreams, trauma, and prediction errors
Gabriel Corda: Memoria episódica y trastorno de estrés postraumático en animales no humanos: una propuesta metodológica
María López Ríos, Christopher Jude McCarroll, and Paloma Muñoz Gómez: Memory, mourning, and the Chilean constitution
Sergio Daniel Rojas-Sierra, and Tito Hernando Pérez Pérez: Subjetividades rememorantes, marcas narrativas y trauma cultural en la construcción de memoria de desmovilizados de las FARC-EP en el AETCR Pondores
Germán Bonanni: Y después de la guerra... ¿Qué?
... Lucid dreams often originate spontaneously (Stumbrys et al., 2014) but can also be induced via induction methods (Tan & Fan, 2022). LD has clinical and practical applications, including nightmare treatment (Ouchene et al., 2023), alleviating insomnia (Ellis et al., 2021), creative problem-solving (Stumbrys & Daniels, 2010), and training motor skills (Bonamino et al., 2023a). Typically, lucid dreamers prioritise fun and pleasure during LD over more practical applications (Schädlich & Erlacher, 2012;. ...
... Children and adolescents, for instance, have reported that their first LD experiences commenced in dream situations of need, e.g., when needing to escape nightmares (Voss et al., 2012). Further, the effectiveness of LD for treating nightmares is supported by several clinical interventions (Ouchene et al., 2023). ...
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
... The fascination with the contents and 45 meaning of our dreams dates back to early human civilizations [1], but despite sig- 46 niőcant progress in dream research, fundamental questions about the physiological 47 and psychological functions of dreaming remain unanswered, leaving us to ponder the 48 question: why do we dream [2]? One step closer towards answering this question is to 49 understand the nature of what we dream. This question is important not only in that 50 it could help us understand the fundamental function of dreams but also as it offers 51 a window into our psyche and what is prominent in people's minds in a given time. ...
... Scores higher/lower than one indicate that dreams of the given type feature the theme more/less often than other dreams. are more likely to occur when dream control is involved [46], and the current results 407 highlight the importance of focusing future clinical applications of lucid dreaming on 408 the dream control rather than simply awareness of the dream (see [49] for a review of 409 the clinical efficacy of lucid dreams to treat nightmares). ...
Dreaming is a fundamental but not fully understood part of human experience. Traditional dream content analysis practices, while popular and aided by over 130 unique scales and rating systems, have limitations. Often based on retrospective surveys or lab studies, and sometimes on in-home dream reports collected over some days, they struggle to be applied on a large scale or to show the importance and connections between different dream themes. To overcome these issues, we developed a new, data-driven mixed-method approach for identifying topics in free-form dream reports through natural language processing. We applied this method on 44,213 dream reports from Reddit's \rdreams subreddit, where we uncovered 217 topics, grouped into 22 larger themes: the most extensive collection of dream topics to date. We validated our topics by comparing it to the widely-used Hall and van de Castle scale. Going beyond traditional scales, our method can find unique patterns in different dream types (like nightmares or recurring dreams), understand topic importance and connections (like finding a greater predominance of indoor location settings in Reddit dreams than what was in general stipulated by previous work), and observe changes in collective dream experiences over time and around major events (like the COVID-19 pandemic and the recent Russo-Ukrainian war). We envision that the applications of our method will provide valuable insights into the complex nature of dreaming and its interplay with our waking experiences.
... Given the parallels between the dreaming and waking body, lucid dream practice could serve as a valuable tool for refin-ing real-world motor skills. However, achieving a stable and controlled dream state remains essential for maximizing its benefits in skill improvement, but also clinical applications such as lucid dream nightmare therapy (Ouchene et al., 2023). ...
Lucid dreaming (LD), during which the dreamer becomes aware of the dream state, offers a unique opportunity for a variety of applications, including motor practice, personal well-being, and nightmare therapy. However, these applications largely depend on a dreamer's ability to control their dreams. While LD research has traditionally focused on induction techniques to increase dream frequency, the equally crucial skill of dream control remains underexplored. This study provides an initial investigation into the mechanisms of dream control and its potential influencing factors. We specifically examined whether a complex motor skill -juggling- could be performed within a lucid dream, creating a particularly challenging lucid dream task, which calls for a high level of dream control. Eight healthy participants (aged 24-50) underwent overnight polysomnography (PSG) at the University of Bern's Institute for Sports Science, provided detailed dream reports, and completed questionnaires assessing dream control, self-efficacy, personality traits, mindfulness, motivation, and intention setting. Of these, four participants experienced lucid dreams, and of these, two demonstrated high dream control with successful LD juggling attempts. Trait differences between non-lucid and lucid dreamers in the lab were examined, with a focus on low-to-no dream control versus high dream control among the lucid dreamers. The two lucid dream juggling attempts are described in detail, providing insight into the challenges of executing complex tasks within a lucid dream. While this study lacks in sample size, it highlights the potential roles of many psychological traits, such as belief, motivation, and self-efficacy, in shaping dream control abilities. This study helps to lay the groundwork for future research aimed at investigating lucid dream control and therefore optimizing LD applications in therapy, sports training, and cognitive science.
... These attributes can also be leveraged in more applied research, particularly within the clinical field. Indeed, lucid dreaming shows promise as a treatment for insomnia, nightmare disorders, and related symptoms (de Macêdo et al., 2019;Ellis et al., 2021a;Ouchene et al., 2023;. Additionally, lucidity may be harnessed in motor and sports sciences, as studies suggest that practicing specific movements during LDs may lead to improvements in wakeful performance (Erlacher & Schredl, 2010;Schädlich & Erlacher, 2018). ...
Sleep is often perceived as a state of disconnection from the environment. Yet, accumulating evidence suggests that the brain can monitor and process external stimuli even while asleep. The accompanying subjective experiences, commonly referred to as dreams, are also thought to be influenced by sensory perceptions. However, the precise mechanisms through which sensory stimulation affects dreaming activity remain largely unknown. This work seeks to address this gap through a comprehensive, multi-faceted approach. It begins with a systematic review of the existing literature on the influence of sensory stimulation on dreams, uncovering key findings and identifying current limitations in the field. Following this, an experimental study investigates the use of multimodal sensory stimulation to enhance dream lucidity during REM sleep, highlighting the potential of sensory-based protocols for facilitating real-time communication with dreamers and objectively exploring perceptual awareness during sleep. Finally, the relationship between multimodal stimulation during NREM sleep and EEG aperiodic activity is empirically explored, indicating that aperiodic spectral slopes may serve as informative markers of subjective sleep experiences. By integrating theoretical, experimental, and analytical perspectives, this work aims to deepen the understanding of how external stimuli influence consciousness during sleep. The findings contribute to the growing body of knowledge on the dynamic interplay between the sleeping brain and sensory stimulation, offering valuable insights into how these interactions shape our dreams.
... By accessing the dreamer, external stimulation can act as a lucidity cue, prompting the reflection necessary for dream awareness (Tan & Fan, 2022). Lucid dreaming has applications across various fields, including nightmare therapy, creative problem solving, skill development and personal exploration (Ouchene et al., 2023;Peters et al., 2023;Schädlich & Erlacher, 2012). ...
The connection between the dreamed body and the real physical body remains a subject of ongoing investigation. This study explored how the dreamed body responds to somatosensory stimulation of the physical body, aiming to shed light on the sensory processes that shape our dreaming experiences. We employed a novel within-subject design to compare the incorporation of three different types of bodily stimuli—electrical muscular, galvanic vestibular, and haptic vibration—into dream content, alongside a control sham condition for each stimulus. In total, 24 participants spent one adaptation night, followed by three consecutive test nights in the sleep laboratory. REM awakenings, after sham or stimulation periods, were carried out for dream report collection. In total, 165 dream reports were collected across conditions. While dream incorporation was observed across the three stimulation methods, it occurred equally in both the stimulation and sham conditions for all three modalities. These findings highlight broader methodological challenges in dream incorporation research and raise concerns about potential confounding factors affecting the interpretation of results. Future research with larger sample sizes is needed to detect smaller effect sizes and fully understand the influence of these somatosensory stimuli on dream content. This study employed a rigorous experimental approach to exploring dream incorporation and addressed many methodological challenges in this area. We further suggest areas of improvement to optimize dream incorporation of different sensory modalities.
Graphical Abstract
... Lucid dreaming, in addition to enhancing motor skills, also has clinical applications, such as treating patients suffering with nightmares. Approximately 2-8% of the world, or millions of people, struggle with idiopathic nightmares that greatly reduce sleep quality (Ouchene, 2023). Nightmares do not just affect your quality of sleep but also well-being, waking life, mental health, etc. Lucid dreaming therapy (or LDT) is a practice where you gain consciousness during a nightmare to manipulate the events of the nightmare, and render them normal dreams. ...
... Lastly, as the prospect of inducing lucid dreams outside the lab edges towards becoming a reality, research into therapeutic applications of lucid dreaming becomes all the more important. If it can be proven that having lucid dreams can help people, then apps such as this one can open up a whole new door of therapeutic options for patients (Holzinger et al., 2020;Ouchene et al., 2023). ...
The induction of lucid dreams in ecological settings is critical for a comprehensive understanding of their phenomenology, neural underpinnings, and feasibility for therapies. Recent methods have been developed to deliberately induce lucid dreams, but they are highly dependent on laboratory equipment. Namely, a method known as targeted lucidity reactivation involves pairing sensory cues with a state of mental reflection, tracking sleep stages using polysomnography, and playing sensory cues in REM sleep to induce lucidity. Playing cues during specific sleep stages is a critical component of targeted lucidity reactivation, and to-date there are very limited ways to derive sleep stages without polysomnography or proprietary wearables. To resolve this limitation and promote the testing of targeted lucidity reactivation in a variety of settings, we developed an open-source iOS/watchOS application that performs the entire targeted lucidity reactivation procedure (pre-sleep training, real-time sleep staging, and REM cueing). Critically, the app includes a custom real-time sleep staging algorithm to identify REM sleep using measures derived from the Apple Watch and accessible to any developer. The current study offers a technical framework for future research investigating the feasibility of inducing lucid dreams outside the lab using everyday technology.
... Future work could investigate how accuracy or engagement with this task might predict subsequent TLR-induced lucidity. With more testing, this procedure and related induction procedures could be tested as treatments for sleep disorders such as recurring nightmares and insomnia (Ouchene et al., 2023). Inducing lucid dreams reliably has been a barrier for progress in this field. ...
People typically become aware that a dream was “just a dream” only after awakening. Alternatively, people can become aware that they are dreaming during the dream. These lucid dreams are thought to involve increased prefrontal cortex activity relative to non-lucid dreams, and they are associated with volitional control over dream content. Lucid dreams could be valuable for many purposes, such as part of therapy for nightmares. Yet, research on such applications has been limited by the long-standing challenge of inducing lucid dreams. Recent studies made progress in showing that memory reactivation during an early-morning nap can induce lucid dreams. Here, we propose that reactivating mindfulness during REM sleep can also be an effective strategy for inducing lucid dreams. A brief literature review and preliminary results support this notion. In this pilot study, participants (N = 5) underwent a wake-back-to-bed procedure with standard polysomnography to track sleep stages and verify lucid dreams with electro-ocular eye signaling. After ap-proximately 5 hours of sleep, participants were awakened to complete a breath-counting task while ambient music cues played in the background. When participants returned to sleep and reached REM sleep, cues were replayed to reactivate the task context. This procedure induced signal-verified lucid dreams in two participants. This rate of induction success approached that of recent full-scale investigations, though additional evidence will be needed to substantiate these initial results. Nevertheless, the present findings suggest that mindfulness-associated sensory stimulation in REM sleep has high potential value for promoting lucid dreaming.
... Additionally, because individuals with narcolepsy are much more likely to have lucid dreams (Dodet et al., 2015;Rak et al., 2015) and have reported an increased capacity to use lucid dreaming for relief from nightmares (Dodet et al., 2015), it may be beneficial to incorporate strategies to promote lucid dream control. There is evidence that lucid dreaming therapy can reduce nightmares in adults, though no studies have included individuals with narcolepsy (Ouchene et al., 2023). Lucid dreams have been reliably induced in the laboratory by presenting stimuli during REM sleep that were previously paired with a lucid mental state, a technique called targeted lucidity reactivation (TLR) (Carr et al., 2020;Konkoly et al., 2021). ...
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.
... When individuals become lucid (i.e., recognizing the dream as such while still asleep), they often gain the ability to perform deliberate actions in their dreams (Mota-Rolim et al., 2013;Stumbrys et al., 2014), a characteristic that is generally absent in typical dreams. Control in lucid dreams might be beneficial in various clinical settings that look to improve sleep or manage sleep disorders (de Macêdo et al., 2019;Ouchene et al., 2023). In Lucid Dreaming Therapy (LDT), an approach still in its infancy, the insight and control of lucid dreaming are thought to serve a useful route for various nightmare-resolution tactics (Fig. 1). ...
Standard treatments for nightmares focus on waking activities, with consequences for subsequent sleep. An alternative strategy may be to provide people with a novel way to learn to end a nightmare by waking up. People typically think of sleep as a state that they cannot control, but there are exceptions to this rule. For example, the ability to select dream content in a lucid dream might allow one to wake up deliberately, thus countering the typical helplessness of nightmares. However, documented evidence that this strategy can work is lacking. Therefore, we recruited healthy participants to complete a task during their next lucid dream; they were instructed either to attempt to wake up or to clench their fists. In the former case, we offered several options for how to wake up. After sleep, participants responded to a detailed survey about their dream and their subsequent awakening experience. Relative to those who clenched their fists, participants who attempted to wake up from the dream by closing their eyes reported waking up sooner after task completion. Furthermore, higher levels of lucidity and lucid-dream skills while dreaming were correlated with a quicker wake-up time and reduced negative emotions. This research showed that people can succeed in waking up from sleep intentionally while lucid dreaming. Because lucid dreaming is trainable, training for waking up in this way could constitute a viable therapeutic approach to relieve nightmare suffering.
... On contrary, a study demonstrated that there is positive relationship of being refreshed after the night of having lucid dreaming . Lucid dreaming therapy (LDT) can be used as the effective intervention technique for reducing nightmare frequency (Ouchene et al., 2023). Lucid dreaming used as treatment technique for nightmares, helped the patient in decreasing the intensity, frequency, and psychological distress (De Macêdo et al., 2019). ...
The current study aimed to predict the relationship between personality traits and dreaming experiences use among young adults, associated with sleep quality and it also aimed to see the gender differences among personality traits and dreaming experiences. A sample of 350 young adults ranging in age from 18-25 years was collected from Wah Cantt, and Islamabad using convenient sampling strategy. The sample of the study consisted of (n= 137) males and (n= 213) females. The data was collected from young adults using measure for personality traits and dreaming experiences, and sleep quality use i.e., Big Five Inventory (BFI), Sleep Quality Scale (SQS), and Mannheim Dream Questionnaire (MADRE). Descriptive statistics such as Pearson correlation, and t-test were used to draw study results. The results of the present study demonstrated that the relationship between study variables is significant and in desirable direction. The findings of the study revealed that females score higher than males in exhibiting neuroticism. The results further indicated that most young adults didn’t have nightmares and lucid dreaming.
... [52][53][54] Our results offer a cohesive explanation for these differential findings, in that we observed a general heightened realness and emotion in lucid dreams (themes of Feeling and Sights and visions and keywords of felt-real) without attachment to positive or negative valence. Our recent findings, focused on a different subreddit (r/LucidDreaming) suggest that positively-valenced lucid dreams are more likely to occur when dream control is involved, 52 and the current results highlight the importance of focusing future clinical applications of lucid dreaming on the dream control rather than simply awareness of the dream (see 55 for a review of the clinical efficacy of lucid dreams to treat nightmares). ...
Dreaming is a fundamental but not fully understood part of human experience that can shed light on our thought patterns. Traditional dream analysis practices, while popular and aided by over 130 unique scales and rating systems, have limitations. Mostly based on retrospective surveys or lab studies, they struggle to be applied on a large scale or to show the importance and connections between different dream themes. To overcome these issues, we developed a new, data-driven mixed-method approach for identifying topics in free-form dream reports through natural language processing. We tested this method on 44,213 dream reports from Reddit's r/Dreams subreddit, where we found 217 topics, grouped into 22 larger themes: the most extensive collection of dream topics to date. We validated our topics by comparing it to the widely-used Hall and van de Castle scale. Going beyond traditional scales, our method can find unique patterns in different dream types (like nightmares or recurring dreams), understand topic importance and connections, and observe changes in collective dream experiences over time and around major events, like the COVID-19 pandemic and the recent Russo-Ukrainian war. We envision that the applications of our method will provide valuable insights into the intricate nature of 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 explore the possible neurobiological basis of these associations. Furthermore, we delve into 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.
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.
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.
Nightmares in children and adolescents are common, but rarely investigated. Although most nightmares in children and adolescents do not require treatment, it might be necessary if the nightmares pertain or induce pronounced impairments or complaints. This article gives an overview of nightmare treatments for children and adolescents and treatment evaluation. Nightmares can be treated most effectively with imagery rehearsal therapy (IRT). For adults, as well as for children and adolescents, IRT includes the recapitulation of a nightmare, its modification into a non-harming dream-sequence, and the repeated imagination of this modified dream. For children and adolescents, however, the modification of the nightmare should be undertaken with age-sensitive methods, like drawing, tinkering, playing with puppets, role-playing, or writing songs. A manualized version of an IRT for children and adolescents is presented.
A 23-yr.-old young woman presenting with a 17-yr. history of nightmares was treated with a variety of behavioral and self-regulatory techniques. The nightmares were unusual in that they did not have an obviously common theme as in most published reports, and, therefore, did not readily lend themselves to several frequently used techniques. Although previous treatment episodes had not affected the incidence of the nightmares, a combination of relaxation procedures, a mnemonic to increase lucid dreaming, and dream rehearsal upon waking from a nightmare resulted in a sharp decrease in the frequency of nightmares in four sessions. Further improvement was reported over the next nine months as additional techniques were introduced and other problems treated, and was maintained during a 9-mo. follow-up.
A previous study in military veterans with posttraumatic stress disorder (PTSD) and recurrent nightmares found a high prevalence of lucid dreaming (LD), the awareness while a dream continues that one is dreaming, and an "LD profile" characterized by frequent dream awareness and rare dream content control. Given the importance of the nightmare disturbance in PTSD, this study assessed with questionnaires the prevalence and characteristics of lucid nightmares, specifically, in a sample of 54 veterans with PTSD. Over half the sample endorsed experiencing LD, with nearly all of these individuals explicitly reporting lucidity in nightmares. The lucid nightmare profile was characterized by high awareness and low content control. Veterans reported feeling stuck and anxious, trying unsuccessfully to awaken from lucid nightmares. We conclude that lucid nightmares may occur commonly in veterans with PTSD, with a profile resembling that previously reported for LD experiences generally in this group.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews. © 2021 Page et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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.
Lucid dreaming refers to a dream state characterized by the dreamers’ awareness of being in a dream and being able to volitionally control its content. The aim of this study was to describe and model neurophysiological evidence for the seven awareness criteria of lucid dreaming based on those proposed by Paul Tholey. Each of the awareness criteria was analyzed separately with regard to its underlying neurocircuits. We hypothesized that not one, but several regions are involved in the state of lucid dreaming. Our results have shown a satisfactory overlap of the awareness criteria and the brain regions activated. During lucid dreaming, a brain network seems to emerge, that is something other than the sum of its parts. Further research is needed to understand the psychoneurological underpinnings of lucid dreams.
Abstract Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. This disease affects significantly the overall patient functioning, interfering with social, work, and affective life. Some symptoms of narcolepsy depend on emotional stimuli; for instance, cataplectic attacks can be triggered by emotional inputs such as laughing, joking, a pleasant surprise, and also anger. Neurophysiological and neurochemical findings suggest the involvement of emotional brain circuits in the physiopathology of cataplexy, which seems to depending on the dysfunctional interplay between the hypothalamus and the amygdala associated with an alteration of hypocretin levels. Furthermore, behavioral studies suggest an impairment of emotions processing in narcolepsy-cataplexy (NC), like a probable coping strategy to avoid or reduce the frequency of cataplexy attacks. Consistently, NC patients seem to use coping strategies even during their sleep, avoiding unpleasant mental sleep activity through lucid dreaming. Interestingly, NC patients, even during sleep, have a different emotional experience than healthy subjects, with more vivid, bizarre, and frightening dreams. Notwithstanding this evidence, the relationship between emotion and narcolepsy is poorly investigated. This review aims to provide a synthesis of behavioral, neurophysiological, and neurochemical evidence to discuss the complex relationship between NC and emotional experience and to direct future research.
Abstract Humans typically lack awareness that they are dreaming while dreaming. However, at times a remarkable exception occurs and reflective consciousness can be regained while dreaming, referred to as lucid dreaming. While most individuals experience lucid dreams rarely there is substantial variance in lucid dream frequency. The neurobiological basis of lucid dreaming is unknown, but evidence points to involvement of anterior prefrontal cortex (aPFC) and parietal cortex. This study evaluated the neuroanatomical/neurofunctional correlates of frequent lucid dreams and specifically whether functional connectivity of aPFC is associated with frequent lucid dreams. We analyzed structural and functional magnetic resonance imaging from an exceptional sample of fourteen individuals who reported ≥3 lucid dreams/week and a control group matched on age, gender and dream recall that reported ≤1 lucid dream/year. Compared to controls, the frequent lucid dream group showed significantly increased resting-state functional connectivity between left aPFC and bilateral angular gyrus, bilateral middle temporal gyrus and right inferior frontal gyrus, and higher node degree and strength in left aPFC. In contrast, no significant differences in brain structure were observed. Our results suggest that frequent lucid dreaming is associated with increased functional connectivity between aPFC and temporoparietal association areas, regions normally deactivated during sleep.
Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.
Background
Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making.
We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature.
Results
Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan.
As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users.
Conclusions
Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
Goal of this series of cases was to investigate lucid dreaming treatment for nightmares. Hypotheses were that lucid dreaming treatment would decrease nightmare frequency and state/trait anxiety, and improve the quality of sleep. Eight participants received a one-hour individual session, which consisted of lucid dreaming exercises and discussing possible constructive solutions for the nightmare. Nightmare frequency and sleep quality were measured by a sleep questionnaire, anxiety was measured by the Spielberger State and Trait Anxiety Inventory. At the follow-up two months later the nightmare frequency had decreased, while the sleep quality had increased slighty. There were no changes on state and trait anxiety. Lucid dreaming treatment seems to be effective in reducing nightmare frequency, although the effective factor remains unclear.
Lucid dreaming is a learnable, but difficult skill. Consequently, we have sought methods for helping dreamers to realize that they are dreaming by means of external cues applied during REM sleep, which if incorporated into dreams, can remind dreamers that they are dreaming. Here we report on an experiment testing the validity and effectiveness of a portable computerized biofeedback device (DreamLight®) designed to deliver light cues during REM sleep. The 14 subjects used DreamLights on 4 to 24 nights. They were unaware that the DreamLights were specially programmed to deliver cues only on alternate nights. Eleven subjects reported 32 lucid dreams, 22 from nights with light cues, 10 from nights without cues. All lucid dreams scored (by judges blind to DreamLight condition) as being "cued" by the DreamLight’s stimuli occurred on nights when the DreamLight was actually delivering cues. Subjects reported seeing in their dreams what they believed to be DreamLight cues significantly more often on light cue nights (73 total) compared to nights without light cues (9). The conclusion is that cueing with sensory stimuli by the DreamLight appears to increase a subject’s probability of having lucid dreams, and that most of the resulting lucid dreams are due to the specific effect of light cues rather than general "placebo" factors.
To investigate the neural correlates of lucid dreaming.
Parallel EEG/fMRI recordings of night sleep.
Sleep laboratory and fMRI facilities.
Four experienced lucid dreamers.
N/A.
Out of 4 participants, one subject had 2 episodes of verified lucid REM sleep of sufficient length to be analyzed by fMRI. During lucid dreaming the bilateral precuneus, cuneus, parietal lobules, and prefrontal and occipito-temporal cortices activated strongly as compared with non-lucid REM sleep.
In line with recent EEG data, lucid dreaming was associated with a reactivation of areas which are normally deactivated during REM sleep. This pattern of activity can explain the recovery of reflective cognitive capabilities that are the hallmark of lucid dreaming.
Nightmares are a common disorder with serious consequences. Recently, the cognitive behavioral interventions Imagery Rehearsal Therapy (IRT) and exposure proved effective in a self-help format. The aim of the current study was to compare the following self-help formats to a waiting-list: IRT; IRT with sleep hygiene; and IRT with sleep hygiene and a lucid dreaming section. Two-hundred-seventy-eight participants were included and randomized into a condition. Follow-up measurements were 4, 16, and 42 weeks after baseline. Seventy-three participants filled out all questionnaires and 49 returned the nightmare diaries. Contrary to our expectations, the original IRT was more effective than the two other intervention conditions. Moreover, IRT was the only intervention that convincingly proved itself compared to the waiting-list condition. However, these data should be interpreted with caution due to the low power and high dropout. Yet it seems that in a self-help format, IRT and exposure (which was validated previously) are the treatments of choice for treating nightmares.
Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C. The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.
The goal of the study was to seek physiological correlates of lucid dreaming. Lucid dreaming is a dissociated state with aspects of waking and dreaming combined in a way so as to suggest a specific alteration in brain physiology for which we now present preliminary but intriguing evidence. We show that the unusual combination of hallucinatory dream activity and wake-like reflective awareness and agentive control experienced in lucid dreams is paralleled by significant changes in electrophysiology.
19-channel EEG was recorded on up to 5 nights for each participant. Lucid episodes occurred as a result of pre-sleep autosuggestion.
Sleep laboratory of the Neurological Clinic, Frankfurt University.
Six student volunteers who had been trained to become lucid and to signal lucidity through a pattern of horizontal eye movements.
Results show lucid dreaming to have REM-like power in frequency bands delta and theta, and higher-than-REM activity in the gamma band, the between-states-difference peaking around 40 Hz. Power in the 40 Hz band is strongest in the frontal and frontolateral region. Overall coherence levels are similar in waking and lucid dreaming and significantly higher than in REM sleep, throughout the entire frequency spectrum analyzed. Regarding specific frequency bands, waking is characterized by high coherence in alpha, and lucid dreaming by increased delta and theta band coherence. In lucid dreaming, coherence is largest in frontolateral and frontal areas.
Our data show that lucid dreaming constitutes a hybrid state of consciousness with definable and measurable differences from waking and from REM sleep, particularly in frontal areas.
A brief case history of a young male farm worker who suffered recurrent nightmares subsequent to being run over by a tractor is given. A method for reducing the nightmares, by encouraging the patient to alter a small, emotionally nonsignificant detail of the dream, is then described.
Lucid dreams occur when a person becomes aware that he or she is dreaming while still in the dream state. Previous reports on the use of lucid dreaming in the treatment of nightmares do not contain adequate baseline data, follow-up data, or both.
A treatment of recurrent nightmares incorporating progressive muscle relaxation, guided imagery, and lucid dream induction is presented for 2 case studies. Three other cases were treated with lucid dream induction alone. The duration of the nightmares ranged from once every few days to once every few months.
The procedures were effective in all 5 cases. A 1-year follow-up showed that 4 of the subjects no longer had nightmares and that 1 subject experienced a decrease in the intensity and frequency of her nightmares.
The alleviation of recurrent nightmares in these 5 cases parallels the results reported by other authors who have used training in lucid dreaming to treat nightmares. Our results support the idea that treatments based on lucid dream induction can be of therapeutic value. Based on these and other case studies, it remains unclear whether the principal factor responsible for the alleviation of nightmares is lucidity itself, or the ability to alter some aspect of the dream.
Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention. The most commonly used tool for randomised trials is the Cochrane risk-of-bias tool. We updated the tool to respond to developments in understanding how bias arises in randomised trials, and to address user feedback on and limitations of the original tool.
Introduction:
Nightmare disorder affects approximately 4% of adults, occurring in isolation or as part of other disorders such as posttraumatic stress disorder (PTSD), and can significantly impair quality of life. This paper provides the American Academy of Sleep Medicine (AASM) position regarding various treatments of nightmare disorder in adults.
Methods:
A literature search was performed based upon the keywords and MeSH terms from the Best Practice Guide for the Treatment of Nightmare Disorder in Adults that was published in 2010 by the AASM. The search used the date range March 2009 to August of 2017, and sought to find available evidence pertaining to the use of behavioral, psychological, and pharmacologic therapies for the treatment of nightmares. A task force developed position statements based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statements.
Determination of position:
Positions of "recommended" and "not recommended" indicate that a treatment option is determined to be clearly useful or ineffective/harmful for most patients, respectively, based on a qualitative assessment of the available evidence and clinical judgement of the task force. Positions of "may be used" indicate that the evidence or expert consensus is less clear, either in favor or against the use of a treatment option. The interventions listed below are in alphabetical order within the position statements rather than clinical preference: this is not meant to be instructive of the order in which interventions should be used.
Position statements:
• The following therapies are recommended for the treatment of PTSD-associated nightmares and nightmare disorder: image rehearsal therapy. • The following therapies may be used for the treatment of PTSD-associated nightmares: cognitive behavioral therapy; cognitive behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. • The following therapies may be used for the treatment of nightmare disorder: cognitive behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam. • The following are not recommended for the treatment of nightmare disorder: clonazepam and venlafaxine. • The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, accessible treatment options, and resources.
Introduction
Lucid dreaming (LD) involves awareness, while dreaming, that one is dreaming and metacognitive monitoring of the ongoing dream. Estimates of LD in general population samples are 31–37% with rare (< one per month), and 20–30% with frequent (≥ one per month), LD. The study of LD has important applications for examining the nature of consciousness during sleep and for understanding and treating dream disturbances including posttraumatic nightmares. LD can be assessed tri-dimensionally: dream awareness, dream content control, and control of waking from a dream. We have reported that a group of Veterans with PTSD and recurrent nightmares demonstrated a LD profile characterized by high dream awareness and low dream content control. Here we examined whether the LD profiles of Veterans with PTSD differed between LD in non-nightmare dreams and in nightmares.
Methods
Thirty-two Veterans with current PTSD (mean age = 42, range = 24 - 60; 19% female) were recruited from the Crescenz VAMC Mental Health Clinic. They completed self-report questionnaires including the Nightmare Frequency Questionnaire, the LD subscale of the Iowa Sleep Experiences Scale, and the Lucidity and Consciousness in Dreams Scale. Lucidity in non-nightmare dreams and in nightmares was assessed.
Results
Eighty-eight percent of participants reported at least one nightmare per week (mean = 4.7). Fifty-four percent had frequent awareness of non-nightmare dreams; only 22% had non-nightmare dream content control. Eighty-two percent had frequent awareness of nightmares; only 24% had nightmare content control.
Conclusion
Compared to general population samples, Veterans with PTSD had a higher percentage of frequent lucid dreamers. For non-nightmare dreams, and more prominently for nightmares, they demonstrated a LD profile characterized by high dream awareness and low dream content control. The combination of high conscious awareness of dreaming and inability to control dream content may contribute to the distress of posttraumatic nightmares. These findings can be applied to the development of novel treatments for the nightmare disturbance in PTSD.
Support (If Any)
Veterans Integrated Service Network 4 Mental Illness Research Education and Clinical Center
The aim of the present exploratory clinical study was to evaluate LD as an add-on therapy for treating nightmares.
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.
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).
Lucid dreaming, in combination with Gestalt therapy, is a potent technique to reduce nightmare frequency and improve the subjective quality of sleep.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Study objective:
Nightmares are a frequent symptom in narcolepsy. Lucid dreaming, i.e., the phenomenon of becoming aware of the dreaming state during dreaming, has been demonstrated to be of therapeutic value for recurrent nightmares. Data on lucid dreaming in narcolepsy patients, however, is sparse. The aim of this study was to evaluate the frequency of recalled dreams (DF), nightmares (NF), and lucid dreams (LDF) in narcolepsy patients compared to healthy controls. In addition, we explored if dream lucidity provides relief during nightmares in narcolepsy patients.
Design:
We interviewed patients with narcolepsy and healthy controls.
Setting:
Telephone interview.
Patients:
60 patients diagnosed with narcolepsy (23-82 years, 35 females) and 919 control subjects (14-93 years, 497 females).
Interventions:
N/A.
Measurements and results:
Logistic regression revealed significant (P < 0.001) differences in DF, NF, and LDF between narcolepsy patients and controls after controlling for age and gender, with effect sizes lying in the large range (Cohen's d > 0.8). The differences in NF and LDF between patients and controls stayed significant after controlling for DF. Comparison of 35 narcolepsy patients currently under medication with their former drug-free period revealed significant differences in DF and NF (z < 0.05, signed-rank test) but not LDF (z = 0.8). Irrespective of medication, 70% of narcolepsy patients with experience in lucid dreaming indicated that dream lucidity provides relief during nightmares.
Conclusion:
Narcolepsy patients experience a markedly higher lucid dreaming frequency compared to controls, and many patients report a positive impact of dream lucidity on the distress experienced from nightmares.
Background and Objectives: Nightmare is a common sleep disorder. While a sleep disorder such as insomnia can readily be associated with psychiatric disorders, the same cannot be said of nightmare. The objective of this study was to determine the prevalence rate of nightmare in a sample of psychiatric patients, and to compare this rate with the rate obtained in age- and sex- matched healthy control subjects in order to determine if there is a significant difference in the rates of nightmare in the different groups. Methods: Ninety - four randomly selected psychiatric patients made up of 54 schizophrenic patients and 40 depressed patients were recruited into the study. One hundred and twenty - three age- and sex- matched randomly selected control subjects were also recruited into the study. A questionnaire determining the one year prevalence of nightmare was administered to all the subjects. Each of them was required to indicate whether he or she had experienced nightmare in the previous one year and if so to indicate the number of episodes experienced during the said period. Results: The results showed prevalent rates of nightmare of 4.9%, 16.7% and 17.5% respectively for the healthy control subjects, schizophrenic patients and depressed patients. There was an overall prevalence rate of 17% among the psychiatric patients (schizophrenic patients and depressed patients) as against 4.9% in the healthy control subjects. Among those who experienced nightmare, the mean values for the number of episodes within the previous one year were, respectively 18 (sd = 6.6) for healthy control subjects (n = 6), 42.7 (sd = 6.3) for schizophrenic patients (n = 9) and 44.6 (sd = 5.9) for depressed patients (n = 7). Conclusions: The findings in this study provide support for a significant association between nightmare and schizophrenia as well as nightmare and depressive illness. In effect, there is a significant association between nightmare and psychopathology.
As the name suggests, evidence-based medicine (EBM), is about finding evidence and using that evidence to make clinical decisions. A cornerstone of EBM is the hierarchical system of classifying evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions. Several papers published in Plastic Surgery journals concerning EBM topics have touched on this subject. 1–6 Specifically, previous papers have discussed the lack of higher level evidence in PRS and need to improve the evidence published in the journal. Before that can be accomplished, it is important to understand the history behind the levels and how they should be interpreted. This paper will focus on the origin of levels of evidence, their relevance to the EBM movement and the implications for the field of plastic surgery as well as the everyday practice of plastic surgery.
The purpose of this study was to investigate whether insomnia symptoms and nightmares are related to suicidal ideation independent of one another and independent of the symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD).
The study consisted of questionnaires examining insomnia symptoms and nightmares, and symptoms of depression, anxiety, and PTSD. The questionnaires were administered online.
University.
583 undergraduate students at a large, public university in southeastern United States.
N/A.
Results indicated that both nightmares and insomnia symptoms were related to suicidal ideation, independent of one another. Nightmares, but not insomnia symptoms, were related to suicidal ideation after controlling for the symptoms of anxiety, depression, and PTSD.
Nightmares may be more than a marker of PTSD and hence may be important in the identification of suicidal ideation.
Nightmares, distressing dreams that primarily arise from REM sleep, are prevalent among the general population and even more so among clinical populations. The frequency of nightmares and related nightmare distress are linked to both sleep disturbance and waking psychopathology. Based on the extant evidence, nightmares appear to be particularly relevant to posttraumatic stress disorder, and may even be implicated in its pathophysiology. Significant advances in treatment have occurred in recent years, with effective pharmacological and psychosocial interventions now available. Despite the progress that has been made, however, more consistent assessment methods and more rigorous study designs are needed to fully understand the causes and consequences of nightmares.
The aim of this prospective study was to determine if sleep disturbances and nightmares are associated with increased risk of repeat suicide attempt. Patients (n=165) aged 18-68 years who were admitted to medical or psychiatric wards after a suicide attempt completed an initial interview; 98 of these took part in a 2-month follow-up interview. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and two self-report instruments, the Uppsala Sleep Inventory and the Comprehensive Psychopathological Rating Scale (CPRS) Self-Rating Scale for Affective Syndromes, were administered both at baseline and follow-up. Data concerning repeat suicide attempts within 2 years were obtained from hospital records. Analyses were performed using Student's t-test, chi-square test, and logistic regression. In total 42 patients (26%) made at least one repeat suicide attempt within 2 years. While neither difficulties initiating/maintaining sleep nor early morning awakening at baseline predicted repeat attempt, having frequent nightmares did (OR=3.15). The risk was further heightened when nightmares were reported at both baseline and 2-month follow-up (OR=5.20). These associations remained after adjusting for sex, axis-I DSM-IV diagnoses, and self-reported depression and anxiety symptom intensity. Our findings suggest that nightmares might constitute a marker for increased risk of suicidal behavior.
Reciprocal inhibition is a process of relearning whereby in the presence of a stimulus a non-anxiety-producing response is
continually repeated until it extinguishes the old, undesirable response. A variety of the techniques based on reciprocal
inhibition, such as systematic desensitization, avoidance conditioning, and the use of assertion, are described in detail.
Behavior therapy techniques evaluated on the basis of their clinical efficacy are found to have striking success over traditional
psychoanalytic methods. Currently, more comparative studies are required which will validate the merit of behavior therapy
in the psychotherapeutic field while experimental research should continue to refine the techniques.
Nightmare disorder with acute onset involves the sudden appearance of frightening and disruptive dreams. In severe cases it may involve high levels of anxiety, fear of falling asleep, cognitive deficits secondary to sleep deprivation and so may pose a psychiatric emergency. Standard techniques of dream interpretation appear limited in dealing with such a crisis. Lucid dreaming, the experience of dreaming and simultaneously being aware that one is dreaming is an easily learned technique that may provide effective and dramatic relief. The usefulness of lucid dreaming is illustrated by a case history.
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.
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).
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.
LDT seems effective in reducing nightmare frequency, although the primary therapeutic component (i.e. exposure, mastery, or lucidity) remains unclear.
Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021)
- Higgins
Chapter 8: Assessing risk of bias in a randomized trial. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021)
- Higgins