From Nightmares to a Good Night’s Dream!

Dark side of the dreams conjures up magical beasts with jaws that have come to cripple us.Soon, the breathing increases rapidly and you gasp for breath, which makes you flee the dreamscape. On awakening, a jolt of fear and terror remains, a ghastly feeling of being watched by invisible eyes prolongs, till it slowly eases us back into consciousness. That’s how a nightmare feels!

Nightmares can be vivid and frightening with detailed images that can leave us in a state of panic and fear after we wake up. Children are most susceptible to nightmares before the age of 10 and adults also experience them occasionally.

Dreaming is seen as a thinking process, that is, a continuation of our thought streams from the day. A nightmare arises when the thought process is regarding traumatic issues or anxiety provoking concerns during the REM (Rapid Eye Movement) sleep. In our waking life, by employing defences we ignore our difficulties, however, during sleep these are generally addressed. The causation of nightmares, especially in adults, can be explained by the long standing unresolved conflicts, recurrent trauma’s, anxieties and repressed memories of childhood abuse. Overtime, unresolved nature of the psychological concerns, majorly shape our personalities and unhealthy emotional expression, resulting in impact to the psychosocial functioning as well as our dreams.

From a neuroscience perspective, the neuroimaging studies suggest that the overly activated brain structure, amygdala during REM, seems to be the culprit when it comes to nightmares. Amygdala is an important structure that allows the brain to detect and respond to threats and seems to be involved in producing fear-responses in the dreamer.

Unfortunately, the impact on dreams is not only about experiencing bad dreams, but in some cases, can lead to chronic conditions as well. This may involve nightmare disorders, experiencing recurrent awakenings from sleep with recall of intensely disturbing dreams, involving fear, anxiety and other dysphoric emotions. This results in sleep disturbances, intense distress and hampering of psychosocial functioning. Additionally, night terrors can be experienced, wherein, during the first few hours of sleep, a nightmare can cause a person to scream loudly and thrash around violently in his/her sleep and is unable to wake up during the episode.

The nightmares are also experienced by individuals who have suffered from a Post-traumatic stress disorder. A specific treatment program for nightmares in these individuals has been developed – Exposure, Relaxation and Rescripting Therapy. It involves psychoeducation on PTSD and nightmares, sleep hygiene as well as benefits of altering sleep habits. They also involve exposure to nightmare content and employing relaxing tools simultaneously, re-scripting their nightmares and rehearsing it.

Other novel cognitive-behavioral therapeutic interventions that have been introduced, is the Imagery Rehearsal Therapy (IRT). It’s goal is to reduce the frequency and intensity of nightmares by ‘reprogramming’ them to be less terrifying as and when they occur. A therapist, by following guidelines, provides psychoeducation about sleep and nightmares and further helps an individual to create detailed, non frightening endings of recurrent nightmares, rehearse them and monitor the progress of the same.

Various other psychotherapeutic interventions can be undertaken, one being, dream analysis, which involves recording of dreams right after you wake up to provide information that can be essential for further analysis. In psychotherapy, your feelings and emotions experienced from that dream are recalled and how these emotions are actually felt in your daily life. With emotional recognition and regulation, further recurring thoughts, themes and feelings from your dream are easier to process and if any, meaning from your dreams can be derived with ease. A portion of therapy also focuses on how the information learnt from dreams can be applied to daily life.

Fortunately, research has found the cognitive-behavioral approaches to have long lasting benefits for nightmare sufferers and be more effective than pharmacological interventions. Dreams, which are seen as a ‘royal road to the unconscious’ are used as a tool for deeper exploration, resolve the nightmares and pave a way towards self-awareness. Let’s paint our own reality!

Authorship: Trisha Daruwala, Clinical Psychologist at Synapsium

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