New Approach Developed To Treat Recurring Nightmares

A new approach for eliminating recurring nightmares that are rooted in traumatic events, such as personal violence and military combat, has been developed by a psychology professor at The University of Tulsa.

So far nine people have been treated, and another 25 began treatment this fall as part of a research project to help establish the efficacy of the treatment. The next step would be to train mental health professionals so they could administer the procedure to their patients. The initial research has been funded by a grant of $15,000 from the Oklahoma Center for the Advancement of Science and Technology.

The first experimental treatment was applied to a teenager who had been raped. The results are described in an article, "Treatment of Nightmares Related to Post-Traumatic Stress Disorder in an Adolescent Rape Victim," published in the October issue of the journal, Clinical Case Studies.

University of Tulsa psychology professor Joanne L. Davis developed the treatment. Participants attend a two-hour assessment and the treatment is then administered in three two-hour sessions. Each session takes place once a week. Follow-up assessments are made at three and six months.

Davis said the treatment is a cognitive behavioral technique that addresses several key elements, including the way people think about their nightmares and the trauma, and the behavior they engage in to try to cope.

To begin, participants write out their nightmares in great detail. Themes are then identified in the nightmare, such as feeling powerless, feeling unsafe, lack of trust in others, low self-esteem, lack of control and problems of intimacy. Next, the person is asked to rewrite the nightmare. For example, people who are powerless in their dream now gain control in the rescripted version. The person is then instructed to visualize this new version of the old nightmare for about 15 minutes before going to bed.

In addition, subjects are shown ways they can control thoughts and behavior that are conducive to nightmares, some as simple as avoiding caffeine before going to bed. Also taught are relaxation procedures, such as breathing techniques, and progressive muscle relaxation, where one tenses then relaxes specific muscles.

Davis says most people who have gone through the treatment don't have any more nightmares or are having significantly less frequent nightmares, and the dreams are much less disturbing. Patients include combat veterans, some victims of rape and of domestic violence, and men and women who have suffered sexual abuse.

She says a similar treatment has been used for those suffering nightmares but without a direct association with a traumatic event, and it has been used in specific categories such as trauma induced by combat experiences or sexual assault. The difference is that her treatment is applied more broadly -- in cases in which the patients have suffered any type of trauma or multiple traumas, and the connection between the nightmare and the traumatic event does not have to be explicit or self-evident. Also innovative is the identification of trauma-related themes that are revealed in the nightmare and which are used to help rewrite the dream.

Davis, who specializes in the psychology of trauma and post-traumatic stress disorder (PTSD), said nightmares are considered a hallmark of PTSD. She notes that for a number of people, the nightmare treatment has also eliminated the PTSD.

The prevalence of these trauma-based nightmares in the general population is unknown, but it is estimated that 60 to 70 percent of the U.S. population will experience some kind of trauma during their life, and within that group, Davis points out, it is predicted that perhaps one-fourth will develop PTSD.

The following are examples of some of the patients who have been helped:

-- a woman who had been in an abusive relationship, had nightmares two or three times a week for 20 years. At the three-month follow-up she reported only one minor nightmare.

-- a woman now in her mid-20's had been sexually assaulted by a male relative when she was between the ages of six and 16. The perpetrator, only a few years older than her, entered her bedroom to commit the attacks. She had told her mother, but her mother didn't believe her. The woman suffered from nightmares that replicated the scenario she had been through. In her rewritten dream, when the boy came into the room, "she was very forceful, very powerful" and he would cower. "She took charge and yelled at him to leave, and her mother gave her support and also ordered him out of the room." After treatment, Davis said, the woman reported that she was having fewer and less disturbing nightmares and that her "quality of life had improved substantially, she was getting more sleep, she was controlling her anger and her relationship with her partner had improved."

-- Leslie Warden, who started having disturbing and recurring nightmares about nine months after her 17-year-old daughter Elizabeth died of a seizure while the girl was spending the night at a friend's house. In these dreams, Warden could see her daughter having the seizure but was unable to reach her to help her, as if there were some invisible barrier, and then she could only watch her die.

"The nightmares caused me all sorts of problems," says Warden, such as an inability to focus or concentrate, a serious drawback for a doctoral student. She was always tired and even fell asleep in some evening classes. But Warden was able to nearly eliminate the frequency of the nightmares, which occurred 3 to 4 times a week -- and their intensity. In her rewritten dream, she was able to be with her daughter in her dying moments and help her and speak to her. Warden says the dreams now don't upset her and don't wake her up.

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Clinical Case Studies (Oct-2003)