Content analysis of the dreams of a medical intuitive

INTRODUCTION

Many individuals have had dreams accurately describing their own health problems before any medical diagnosis. Some have even had accurate dreams depicting the health problems of others.

OBJECTIVES

To examine the characteristics of dreams of a practicing medical intuitive. It was hoped to describe in more detail, the differences between her health related dreams and her "normal" or non-health dreams. Her health dreams were all chosen because they successfully described a malady before it was diagnosed by any medical professional.

METHODS

Ninety dreams (30 normal, 30 self health related, 30 for others) were content analyzed using the online Hall-Van de Castle Content Analysis scoring system.

RESULTS

The non-health dreams of the dreamer were significantly longer than the two samples of health dreams (p < .001). The two sets of health dreams did not differ in report length. In terms of content, the health dreams, either for the dreamer herself, or for a patient were composed of precise literal references and descriptions about the nature of the health problem. While there was also some symbolism in a few of these dreams, the symbols were considered very easy to interpret.

CONCLUSIONS

While these dreams were all collected from a very experienced, talented medical intuitive, their structure may be similar to the dreams of many individuals. It would be of value to collect and examine the dreams from a number of individuals that have had health dreams in the course of solving their own health problems.

Virtual reality training of lucid dreaming

Metacognitive reflections on one's current state of mind are largely absent during dreaming. Lucid dreaming as the exception to this rule is a rare phenomenon; however, its occurrence can be facilitated through cognitive training. A central idea of respective training strategies is to regularly question one's phenomenal experience: is the currently experienced world real, or just a dream? Here, we tested if such lucid dreaming training can be enhanced with dream-like virtual reality (VR): over the course of four weeks, volunteers underwent lucid dreaming training in VR scenarios comprising dream-like elements, classical lucid dreaming training or no training. We found that VR-assisted training led to significantly stronger increases in lucid dreaming compared to the no-training condition. Eye signal-verified lucid dreams during polysomnography supported behavioural results. We discuss the potential mechanisms underlying these findings, in particular the role of synthetic dream-like experiences, incorporation of VR content in dream imagery serving as memory cues, and extended dissociative effects of VR session on subsequent experiences that might amplify lucid dreaming training during wakefulness. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Nightmare Distress Questionnaire: associated factors

STUDY OBJECTIVES

The diagnosis of a nightmare disorder is based on clinically significant distress caused by the nightmares, eg, sleep or mood disturbances during the day. The question what factors might be associated with nightmare distress in addition to nightmares frequency is not well studied.

METHODS

Overall, 1,474 persons (893 women, 581 men) completed an online survey. Nightmare distress was measured with the Nightmare Distress Questionnaire.

RESULTS

The findings indicated that nightmare distress, measured by the Nightmare Distress Questionnaire, correlated with a variety of factors in addition to nightmare frequency: neuroticism, female sex, low education, extraversion, low agreeableness, and sensation seeking. Moreover, the percentage of replicative trauma-related nightmares was also associated with higher nightmare distress.

CONCLUSIONS

A large variety of factors are associated with nightmare distress, a finding that is of clinical importance. The construct harm avoidance, however, was not helpful in explaining interindividual differences in nightmare distress. Furthermore, the relationship between nightmare distress and other factors, eg, education or agreeableness, is not yet understood.

Stress overload and the new nightmare for Dreamers

To determine if, following threats to DACA policies, Dreamer college students experienced greater stress overload, more symptoms, and worse grades than their classmates. Participants: Students (n = 424) from a large public university, including Dreamers (n = 64), participated between March 2017 and June 2018. Methods: Students completed an anonymous online survey containing self-report measures of stress overload, symptoms, grades, and background characteristics. Results: Dreamers reported significantly higher levels of stress overload than did other students, including minorities and immigrants. Dreamers reported more somatic symptoms but not lower grades than other students-outcomes mediated, wholly or partially, by stress overload. Conclusion: Findings document the health toll of current politics on Dreamers, and indicate disproportionate stress overload as a reason. They also attest to Dreamer "grit" in maintaining grades nevertheless. Implications include the need for proactive support by universities and broader social policy change to restore well-being to these students.

[A Review of the Posttraumatic Stress Disorder and Sleep Disturbances]

Post-traumatic stress disorder (PTSD) is characterized by intrusive emotional memory, alertness and avoidance after individuals suffer from one or more traumatic events. With the exception of manifestations, sleep disturbances are also considered to be the core symptoms of PTSD. This article mainly discussed insomnia, nightmares, obstructive sleep apnea (OSA), and periodic limb movement during sleep (PLMS) in patients with PTSD. Existing evidence suggested that insomnia is a predictor of the development of PTSD. Cognitive behavioral therapy for insomnia is an important research direction for treating insomnia in PTSD patients. Nightmares are also the core symptom of PTSD. Prazosin and image rehearsal therapy are effective therapies to treat post-traumatic nightmares. The co-occurrence of obstructive sleep apnea (OSA) is over 40% in patients with PTSD. Preliminary studies have shown that continuous positive airway pressure therapy can improve PTSD symptoms in patients with PTSD comorbid OSA. In the process of diagnosis and treatment of PTSD patients, it is important to firstly evaluate whether PTSD patient comorbid OSA or insomnia, and then clinicians could further develop an appropriate treatment plan for these patients.

Dream enactment behavior-a real nightmare: a review of post-traumatic stress disorder, REM sleep behavior disorder, and trauma-associated sleep disorder

NONE

Dream enactment behavior is a phenomenon demonstrated in patients with post-traumatic stress disorder, rapid eye movement sleep behavior disorder, as well as with a more recently described condition entitled trauma-associated sleep disorder, which shares diagnostic criteria for rapid eye movement sleep behavior disorder. While these conditions share some commonalities, namely dream enactment behavior, they are quite different in pathophysiology and underlying mechanisms. This review will focus on these 3 conditions, with the purpose of increasing awareness for trauma-associated sleep disorder in particular.

Apical drive-A cellular mechanism of dreaming?

Dreams are internally generated experiences that occur independently of current sensory input. Here we argue, based on cortical anatomy and function, that dream experiences are tightly related to the workings of a specific part of cortical pyramidal neurons, the apical integration zone (AIZ). The AIZ receives and processes contextual information from diverse sources and could constitute a major switch point for transitioning from externally to internally generated experiences such as dreams. We propose that during dreams the output of certain pyramidal neurons is mainly driven by input into the AIZ. We call this mode of functioning "apical drive". Our hypothesis is based on the evidence that the cholinergic and adrenergic arousal systems, which show different dynamics between waking, slow wave sleep, and rapid eye movement sleep, have specific effects on the AIZ. We suggest that apical drive may also contribute to waking experiences, such as mental imagery. Future studies, investigating the different modes of apical function and their regulation during sleep and wakefulness are likely to be richly rewarded.

Weekday and weekend sleep deprivation are associated with recurrent nightmare in adolescents: a cross-sectional study

OBJECTIVE

Our study aimed to investigate the association between sleep deprivation and parasomnias including nightmare and sleepwalking in Chinese adolescents.

METHODS

A total of 19,229 high school students aged 10-20 in Fuzhou were invited to complete questionnaires regarding sleep duration, parasomnias including nightmare and sleepwalking, and emotional problems. Subjects with sleep deprivation (SD) defined as sleeping less than 8 h either on weekdays or on weekends were categorized as three groups: weekday SD, weekend SD and habitual SD.

RESULTS

The prevalence of recurrent nightmare was significantly higher for subjects with SD (SD vs non sleep deprivation (NSD): 7.6% vs 3.7%). In all subjects, habitual SD was associated with the highest risk of recurrent nightmare [Odds ratio (OR) = 2.19, 95% Confidential interval (95% CI) = 1.73-2.75, P < 0.001], followed by weekday SD (OR = 2.06, 95% CI = 1.64-2.61, P < 0.001) and weekend SD (OR = 1.45, 95% CI = 1.01-2.08, P = 0.045). No significant association was found between sleepwalking and sleep deprivation. In further age-based (10-13/14-17 years) and sex-based subgroup analyses, the findings were consistent except that association between weekend SD and recurrent nightmare disappeared among subjects aged 14-17 or among girls.

CONCLUSIONS

Our study found a significant association between recurrent nightmare and sleep deprivation either on weekdays or on weekends in adolescents, which was stronger with more deprivation episodes. No significant association was found between sleepwalking and sleep deprivation. Association between weekend SD and recurrent nightmare disappeared among subjects aged 14-17 or among girls.

Sexual dream and family relationships in frequent sexual dreamers and healthy volunteers

Early life family relationships affect the sexuality in adulthood, and these influences might be reflected in sexual dreams. The present study was designed to investigate the exact associations between family relationships and sexual dream experience. We therefore invited 62 frequent sexual dreamers (dreamers) and 104 healthy volunteers (controls) to answer the Sexual Dream Experience Questionnaire (SDEQ) and the Family Relationship Questionnaire (FRQ). Compared to controls, dreamers scored higher on all SDEQ factors and sexual dream frequency, higher on FRQ Paternal Abuse, and lower on FRQ General Attachment and Maternal Freedom Release. In controls, Paternal Abuse was associated with Joyfulness, Maternal Dominance with Aversion, and Maternal Abuse with dream frequency (-). In dreamers, Paternal Abuse was associated with Aversion, Bizarreness and dream frequency, and Maternal Freedom Release with Aversion (-). In conclusion, there were pronounced associations between sexual dreams and family relationships in frequent sexual dreamers. Paternal Abuse in particular was associated with sexual dream experience. Adverse family relationships might induce frequent sexual dream occurrence, and family therapy or early intervention of Paternal Abuse might alleviate the negative sexual dream experience.

Is there a relation among REM sleep dissociated phenomena, like lucid dreaming, sleep paralysis, out-of-body experiences, and false awakening?

During REM sleep we normally experience dreams. However, there are other less common REM sleep phenomena, like lucid dreaming (LD), false awakening (FA), sleep paralysis (SP), and out of body experiences (OBE). LD occurs when one is conscious during dreaming, and FA occurs when one is dreaming but believes that has woken up. SP is characterized by skeletal muscle atonia and occurs mainly during awakening or falling asleep. OBE is the subjective sensation of 'leaving the physical body'. Since all these phenomena happen during REM sleep, their frequency is probably connected. The goal of this research is to explore how these phenomena are connected to each other in terms of frequency. We surveyed 974 people on the streets of Moscow and found significant correlations between the phenomena. Of those surveyed, 88% have experienced at least one of the phenomena of interest (i.e., LD, OBE, FA, and SP), which appeared to be closely correlated to each other. Furthermore, 43% of respondents stated that they often experience at least one of these phenomena. We found that the recurrence of these phenomena correlated with sleep duration and dream recall frequency. The results of the survey provide better understanding of the nature of REM sleep dissociative phenomena. Cross-correlations between REM sleep dissociated phenomena, like lucid dreaming, sleep paralysis, out-of-body experiences, and false awakening, revealed by a survey.

Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies

In recent years, there has been a growing interest in understanding the relationship between sleep and suicide. Although sleep disturbances are commonly cited as critical risk factors for suicidal thoughts and behaviours, it is unclear to what degree sleep disturbances confer risk for suicide. The aim of this meta-analysis was to clarify the extent to which sleep disturbances serve as risk factors (i.e., longitudinal correlates) for suicidal thoughts and behaviours. Our analyses included 156 total effects drawn from 42 studies published between 1982 and 2019. We used a random effects model to analyse the overall effects of sleep disturbances on suicidal ideation, attempts, and death. We additionally explored potential moderators of these associations. Our results indicated that sleep disturbances are statistically significant, yet weak, risk factors for suicidal thoughts and behaviours. The strongest associations were found for insomnia, which significantly predicted suicide ideation (OR 2.10 [95% CI 1.83-2.41]), and nightmares, which significantly predicted suicide attempt (OR 1.81 [95% CI 1.12-2.92]). Given the low base rate of suicidal behaviours, our findings raise questions about the practicality of relying on sleep disturbances as warning signs for imminent suicide risk. Future research is necessary to uncover the causal mechanisms underlying the relationship between sleep disturbances and suicide.

How the brain constructs dreams

Deep inside the temporal lobe of the brain, the hippocampus has a central role in our ability to remember, imagine and dream.

Effect of continuous positive airway pressure (CPAP) on mild-moderate obstructive sleep apnea (OSA) related dreaminess: A case report

INTRODUCTION

Dreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue. Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP).

PATIENT CONCERNS

We present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years.

DIAGNOSIS

An overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA.

INTERVENTIONS

The patient received auto CPAP therapy.

OUTCOMES

The symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration.

CONCLUSION

This case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.

Consciousness in Animals

Are humans the only species with a sense of consciousness? This question has intrigued me for most of my life. Having kept pets and livestock animals, and observed wild animals from both near and far, I have often wondered just how much they know about their surroundings and their place in it. Do they know how to reason out answers to questions important to them? Are they aware of the consequences of their actions? Can they anticipate what other animals, including those of close kin and other, more remote species, are likely to do in certain situations? Can they see themselves inside their minds, if they do, indeed, have minds? Do they dream?

The Complexity of Dreams: a Multiscale Entropy Study on Cardiovascular Variability Series

Uncovering the physiological correlates of dreams is one of the most ambitious aim of multidisciplinary neuroscientific research. Here we investigated Autonomic Nervous System (ANS) dynamics associated with a dream recall, with a particular focus on the complexity assessment on cardiovascular control. We recorded electrocardiogram and arterial blood pressure signals from eight healthy subjects during rapid-eye-movement sleep before awakenings. Recordings were then split into two groups: the ones with a dream experience, and the ones without recall of dream experiences. The randomness of cardiovascular variability series was assessed through Sample Entropy metrics, which did not show any statistical difference between groups. On the other hand, a multiscale complexity analysis based on Distribution Entropy and Fuzzy Entropy revealed that a higher cardiovascular complexity is associated with a dreaming experience.

Managing daytime sleepiness with the help of sleepcoaching, a non-pharmacological treatment of non-restorative sleep

Purpose

To measure the effect of a 2-day sleepcoaching seminar on daytime sleepiness and sleep-related variables of shift workers employed in an Austrian railway company (ÖBB: Österreichische Bundesbahnen).

Method

Participants filled in pre- and post-intervention questionnaires, containing items of the PSQI and the ESS, questions about chronotype, personality factors and possible burnout risk factors. About 30 shift workers, working in shifts for more than 300 months on average (28 male; mean age = 24 ± 45.90, age range 24–56 years) voluntarily took part in the investigation twice. Sleep coaching by Holzinger and Kloesch™ (SC) is a new holistic approach for non-pharmacological treatment of non-restorative sleep and is based on Gestalt therapy. It includes psychotherapeutic aspects, which enable clients to improve their sleep quality by developing one’s own coping strategies which can be implemented in daily routine. Dream work and relaxation techniques are also part of the programme.

Results

The 2-day SC seminar was beneficial by focusing on the sleep problems related to shift work. A significant improvement of the global PSQI score and the PSQI variables subjective sleep quality, diurnal fatigue, and sleep latency was achieved, with a medium effect size. However, the programme did not result in the reduction of daytime sleepiness (ESS). Six more variables did not change significantly.

Conclusion

While some sleep problems related to shift work were successfully addressed by SC, daytime sleepiness (ESS) could not be reduced contrary to our expectations. More research with a greater sample and a longitudinal design is needed to examine the long-term effects of SC.

Daydreams: Concealed and Revealed in Analysis

Daydreams and night dreams are similar in that both share the wish fulfillment aspect of dreaming. Even though the difference between day and night dreams is obvious-daydreams happen when a person is awake (conscious) and night dreams happen when a person is asleep (unconscious)-the boundary between day and night dreams becomes blurred when the ego has been severely compromised. The focus of this paper is on the analysis of daydreaming and its relationship to the ego. As in the analysis of nocturnal dreams, analysis of daydreams provides another opportunity for discovery of repressed material. Analysis of daydream material also provides an opportunity to assess the development of a patient's ego. When development of the ego has been severely compromised, daydreaming may become a mechanism of defense. A literature review is presented, followed by discussion of daydreaming and the ego. Case examples illustrate major points in the discussion.

"I May Allow Myself to do This": Conflict in Freud's Writing of The Interpretation of Dreams

An autobiographical interpretation of latent meanings in Freud's Interpretation of Dreams is undertaken in order to explore oedipal themes in Freud's writing and their role in his resistance to writing the book. By looking at how the book performs its message, in presenting a collection of Freud's personal dreams that talk to each other and inspire meaning-making, we can see how readers are drawn into the role of interpreters/analysts. This process makes the oedipal myth palpable long before Freud mentions it. It also illustrates an analytic process that analysts are all required to follow. Finally, the process reveals something in Freud that could be apprehended only after his ideas were conveyed-the unending process of interpretation, in which every conclusion gives rise to new ideas, inspiring new conclusions.

[Sleep disorders and their treatment in post-traumatic stress disorder]

Subjects suffering from post-traumatic stress disorder present sleeping disorders like a chronic insomnia, traumatic nightmares, but also less expected, sleep breathing disorders. Sleep problems are a factor of development and maintenance of PTSD, but also a factor of resistance to treatment. After a therapy focused on PTSD, they represent frequent residual symptoms. It is necessary to couple, with the usual management of PTSD, targeted approaches for sleep problems. These targeted approaches allow an improvement of the nocturnal properties but also diurnal specific symptoms of PTSD. Stakes around primary, secondary and tertiary prevention of PTSD emerge around these sleep disorders.

[Internet-based cognitive behavioral therapy of insomnia and nightmare disorder]

Cognitive behavioral therapeutic interventions are considered to be one of the most effective forms of treatment of various mental disorders. Besides being very frequent, sleep disorders, such as insomnia and nightmare disorder are often not treated effectively and guideline-conform, mainly due to the lack of qualified psychotherapists. Implementation of modern technical options, such as web-based psychotherapy can help to overcome this problem. This article presents the current situation in the treatment of insomnia and nightmare disorders as particularly well-suited fields of application. For insomnia there are several English language and also recently German language options, which for example were also evaluated for the application to work-related stress and sleep disorders. In this respect, procedures with and without contact to a therapist or multicomponent procedures and single interventions can be differentiated. For nightmare disorders imagery rehearsal therapy provides a structure, which can also easily be transferred to an internet-based therapy program. The currently beginning use of internet-based treatment of sleep disorders does not yet utilize all theoretically available technical possibilities. The potential of internet-based therapy is extremely versatile and it remains for medical sleep experts to consider which method can be used for which indications.

Sleep problems in advanced disease

Sleep problems are relatively common in patients with advanced disease, and are associated with significant morbidity in these groups of patients. The focus of this article is sleep problems in patients with advanced cancer, and specifically insomnia, 'vivid' dreams and nightmares. However, other sleep problems are also relatively common in this group of patients, including sleep-related breathing disorders and circadian rhythm sleep-wake disorders. Healthcare professionals should screen all patients with advanced diseases for sleep problems and, equally, initiate appropriate (evidence-based) interventions when they are discovered.

Effect of maternal smoking in pregnancy and childhood on child and adolescent sleep outcomes to 21 years: a birth cohort study

BACKGROUND

The effects of prenatal maternal smoking have been studied extensively, however little research has examined the effects of prenatal exposure to maternal smoking on offspring sleep, particularly over several developmental periods. We examined the effects of prenatal maternal smoking and postnatal smoking from birth to 14 years, on offspring sleep at 6 months, 5, 14 and 21 years.

METHODS

This was a prospective, community-based birth cohort study involving 7223 women who delivered a singleton child in Brisbane, Australia between 1981 and 1983. Women were recruited at the first antenatal visit. Offspring sleep problems were reported by mothers at 6 months, 5 and 14 years, and by youth at 14 and 21 years. 3738 mothers prospectively reported their smoking status from pregnancy to 14 years postpartum. Youth snoring was reported by mothers at 14 years and by youth at 21 years. Multinomial logistic regression analyses were performed.

RESULTS AND DISCUSSION

Prenatal maternal smoking was independently associated with an increased risk of offspring adolescent parasomnias including walking and talking in sleep and nightmares, and an increased likelihood of being in the highest quintile for maternal and youth reported sleep problems at 14 years. Maternal postnatal smoking was associated with increased likelihood of offspring snoring at 14 years.

CONCLUSIONS

Exposure to maternal prenatal smoking has different effects on offspring sleep compared to exposure to postnatal smoking. Prenatal smoking exposure may be associated with changes in neurodevelopment whereas postnatal smoking is more likely to affect the respiratory system. These findings highlight the long lasting and potentially serious clinical effects of exposure to pre and postnatal maternal smoking on offspring, the mechanisms by which warrant further investigation.

Presleep Cognitive Hyperarousal and Affect as Factors in Objective and Subjective Insomnia

The role of presleep cognition in insomnia was studied in normal sleepers and insomniacs with either (1) psychophysiological insomnia, an objective disorder of initiating and maintaining sleep (DIMS), or (2) DIMS without objective findings (subjective insomnia), as defined by two nights’ polysomnographic baseline data. During the experimental night in the sleep laboratory, 24 subjects were interviewed at intervals during the presleep/sleep-onset period. Judges’ ratings of subjects’ spontaneous reports and subjects’ responses to questionnaire items were analyzed for cognitive quality. Objective insomniacs had more frequent cognitive activity than the subjective insomniacs. Both insomnia groups reported more negative thoughts than the controls. Cognitive hyperarousal as a factor in objective insomnia was not clearly supported.

Wedding the dragon: The powerful feminine as seen in Jewish women's dreams

This article addresses the theological and liturgical problem of incorporating mythic traditions of the divine feminine into contemporary practice, given the typically essentialist nature of these traditions. The article considers the dream practice of a Jewish women's learning community, the Kohenet Hebrew Priestess Institute, and applies this practice to several "dragon dreams" in which dragons appear as powerful, erotic, sacred figures that "queer" the divine feminine by offering a norm-upending vision of what the feminine is and does. These dragon dreams provide a powerful alternative to traditional Jewish images of the female dragon in which the dragon represents the demonic feminine. I suggest that dreams can offer a "queering" of mythic images of the sacred feminine because they contain images that have mythic depth but also upend norms and expectations. The article then explores how these dragon images have made their way into the liturgy and theology of the Kohenet Hebrew Priestess Institute.

Intoxication and neurology: A Dream Within a Dream

The author Edgar Allan Poe is one of many artists who describe how it feels to live with major, involuntary changes of consciousness. Are the large upturns and downturns in his life attributable to a neurological conditions, or can substance use and depressive thoughts explain these fluctuations?

Peace of mind and anxiety in the waking state are related to the affective content of dreams

Waking mental well-being is assumed to be tightly linked to sleep and the affective content of dreams. However, empirical research is scant and has mostly focused on ill-being by studying the dreams of people with psychopathology. We explored the relationship between waking well-being and dream affect by measuring not only symptoms of ill-being but also different types and components of well-being. Importantly, this is the first time peace of mind was investigated as a distinct aspect of well-being in a Western sample and in relation to dream content. Healthy participants completed a well-being questionnaire, followed by a three-week daily dream diary and ratings of dream affect. Multilevel analyses showed that peace of mind was related to positive dream affect, whereas symptoms of anxiety were related to negative dream affect. Moreover, waking measures were better related to affect expressed in dream reports rather than participants' self-ratings of dream affect. We propose that whereas anxiety may reflect affect dysregulation in waking and dreaming, peace of mind reflects enhanced affect regulation in both states of consciousness. Therefore, dream reports may possibly serve as markers of mental health. Finally, our study shows that peace of mind complements existing conceptualizations and measures of well-being.

Predictors of treatment noninitiation, dropout, and response for cognitive behavioral therapy for trauma nightmares

OBJECTIVE

This report aims to extend previous findings on predictors of treatment dropout and response within nightmare treatment.

METHOD

Factors predicting treatment noninitiation, dropout, and response were examined in 70 trauma-exposed individuals treated in a randomized controlled trial of 2 conditions (exposure [EX] and nonexposure) of a therapy for trauma nightmares.

RESULTS

Together, treatment noninitiation and dropout was predicted by younger age for the EX condition only and by fewer nights with nightmares at baseline for both conditions. Treatment noninitiation was predicted by fewer nights with nightmares. Treatment dropout was not predicted by any variables. For the EX condition, more baseline nightmares predicted more posttreatment nightmares, whereas more reported nights with nightmares at baseline predicted fewer nightmares at posttreatment. Baseline sleep quality and total posttraumatic stress disorder (PTSD) severity predicted posttreatment sleep quality and PTSD severity, respectively. In the nonexposure condition, more traumatic events predicted fewer nightmares at posttreatment, whereas more nightmares predicted more nightmares at posttreatment. Baseline daytime sleepiness predicted worse posttreatment sleep quality, and total PTSD symptom severity predicted posttreatment PTSD severity.

CONCLUSIONS

Baseline symptom severity on constructs targeted in treatment are the best indicators of response. Treatment initiation appears to be more significant than dropout. Identifying reasons for treatment noninitiation is needed to maximize engagement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[The cause of the lucid dream or the study on the human nature]

Abstract.

Studies in the Physiology of Awareness: the Incidence and Content of Dream Patterns and Their Relationship to Anoxia

The study of dreams is a study of a group of epiphenomena associated with states of diminished awareness. No matter whether such dreaming occurs in natural sleep, in states of reverie interspersing normal levels of consciousness or in pathologically or pharmacologically induced aberrations of consciousness, it would appear that the principle that dreams do not occur other than at levels of lessened awareness is generally accepted. From the point of view of neurophysiology, it also seems reasonably clear that the formation of the visual and auditory hallucinations, illusions and delusions forming the manifest formal content of dreams is dependent upon fairly precise cerebral localization, the temporal lobe and Brodman's area 19 being especially important in these respects (Penfield and Erickson, 1941). Psycho-physiologically a number of attempts have been made to assess the nature and quality of stimuli normally inciting dreams. From Maury (1861) onward the effects of various physical stimuli (Klein, 1930), of auto-suggestion (Arnold-Forster, 1921), of post-hypnotic suggestion (Prince, 1939) and of projection phantasies (Malamud and Linder, 1931) have been noted. Psychologically the dynamics underlying the mechanisms of the dream instinct have been investigated especially by Freud and his followers. Freud's opinion that the dream represents an attempted wish fulfilment has been modified by Jung, who emphasizes its compensatory function, by Adler, who conceived of the dream as a method for testing possible future situations in phantasy, and by Stekel (1943), for whom the dream was a symbolic manifestation of the “internal conflicts” of the individual. Finally, the observations of Monge (1929) concerning the increased incidence of disturbing dreams when dwellers at high altitudes suffer from chronic mountain sickness, and of McFarland (1937) on the changing dream habits of a party of mountaineers in the Chilean Andes as they ascended steadily to ever-increasing altitudes (and hence to progressively greater degrees of anoxic anoxia), are of immediate interest. They are in direct line with the findings of anoxaemia in sleep (Lovett Doust and Schneider, 1951), and suggest a positive relationship between the manifest content of dream patterns, emotional tension, reduced awareness and anoxaemia.

The Mode of the Dream

There have been abundant studies of dreams from the point of view of their content, but few have examined the mode of dreamsirrespectiveof content. For analysing and interpreting the content of dreams first-hand accounts have been used, but these verbalizations—owing to communication limitations alone—are far from identical with the dream experience. These verbalizations necessarily lump together the elements of the experience in order to provide a coherent description.

[Dream - film - psychotherapy]

No abstract available.

The intersubjective links in perversion

The author studies the intersubjective links which the pervert maintains with analyst or partner, attempting to indicate the differences between the investments in each case. Rather than accepting that empathy towards these patients is impossible to achieve and disturbs the countertransference profoundly, it attempts to show that these difficulties may be overcome if they are reinterpreted in the light of the theory of the intersubjective link. The author examines the theories and the practice of intersubjectivity and gives a definition of his approach to the link between two subjects. He applies these ideas to the case of a sexually masochistic female patient. The countertransference is marked successively by indifference, rejection and smothering. The analysis of the analyst's dream allows the situation to evolve. Failures in primary identification can result in domination over others and utilitarianism. The author examines the place of the challenge to the 'Law' and the father (in the attempt by the patient to put a theory to the test) in order to identify the figure of the witness in the pervert's intersubjective links. The desire of the transference would be marked by the figure of the witness rather than by that of the analyst as accomplice.

On talking‐as‐dreaming

Many patients are unable to engage in waking-dreaming in the analytic setting in the form of free association or in any other form. The author has found that "talking-as-dreaming" has served as a form of waking-dreaming in which such patients have been able to begin to dream formerly undreamable experience. Such talking is a loosely structured form of conversation between patient and analyst that is often marked by primary process thinking and apparent non sequiturs. Talking-as-dreaming superficially appears to be "unanalytic" in that it may seem to consist "merely" of talking about such topics as books, films, etymology, baseball, the taste of chocolate, the structure of light, and so on. When an analysis is "a going concern," talking-as-dreaming moves unobtrusively into and out of talking about dreaming. The author provides two detailed clinical examples of analytic work with patients who had very little capacity to dream in the analytic setting. In the first clinical example, talking-as-dreaming served as a form of thinking and relating in which the patient was able for the first time to dream her own (and, in a sense, her father's) formerly unthinkable, undreamable experience. The second clinical example involves the use of talking-as-dreaming as an emotional experience in which the formerly "invisible" patient was able to begin to dream himself into existence. The analyst, while engaging with a patient in talking-as-dreaming, must remain keenly aware that it is critical that the difference in roles of patient and analyst be a continuously felt presence; that the therapeutic goals of analysis be firmly held in mind; and that the patient be given the opportunity to dream himself into existence (as opposed to being dreamt up by the analyst).

The indissociable unity of psyche and soma: A view from the Paris Psychosomatic School

Depending on whether or not psyche/soma is seen as singular or dual, one may construct different systems explaining man and the world, life and death. In the author's view, the discoveries of psychoanalysis offer a perfectly cogent and unique solution to the famous mind/body problem. In transferring the duality psyche/soma on to the duality of drives, psychoanalysis places the origin of the thought process in the body. In Beyond the pleasure principle, Freud discusses the drastic effect of a painful somatic illness on the distribution and modalities of the libido. He provides a starting point for the Paris Psychosomatic School's psychoanalytical approach to patients afflicted with somatic illnesses. To illustrate the technical implications of this theory the author relates two clinical cases.

Dreams that mirror the session

Dreams in which the analyst appears undisguised almost always depict violations of the setting. Often experienced as special, epiphanic moments, they give a glimpse of an intense, emotional reaction to traumatogenic or otherwise significant events that have occurred during the session or in the most recent previous ones. Probably, the essential aspect of these dreams can be found in the 'form of their content'. This may be paralleled by the narrative technique of mise en abyme or mirror-text. The dream appears as a story within the main story and the scene of the analysis is reflected anti-illusionistically. The fictional structure of the setting is emphasized. Its theatrical self-consciousness quality is revealed at its best. The author postulates that the transformative therapeutic value of these dreams derives from denouncing the referential illusion of 'concrete reality' and of 'what really happened'. For the analysand, they are an effective (i.e. emotionally intense) opportunity to discover the spatial articulations and the staggering refractions of the inside/outside, the textual/extra-textual, the psychic reality/material reality. In the continual comings and goings from one term to another, the work of symbolization is reactivated and the subject is constructed. Dreams that mirror the session, from this point of view, provide a model for conceptualizing the analytic work, and their significance goes beyond the specific phenomena referred to. A clinical case is given, in which some of one patient's dreams are considered as they occurred over a short period. In one of them, the dream-within-a-dream phenomenon is present.

On the psychodynamics of collecting

The urge to collect is a ubiquitous phenomenon which has anthropological, sociobiological and individual psychodynamic roots, but occurs far more frequently among men than women. The author examines the reasons for this gender difference and defines systematic collecting to distinguish it from addictive, obsessive and messy collecting, and from related phenomena such as perversion. The mode of collecting and choice of object are important indicators as to the unconscious psychodynamics of a collector and offer opportunity to describe his structural level. Collecting ranges across a broad spectrum, from an ego-syntonic integrated mode, i.e. sublimation, to a neurotic defence against pre-oedipal or oedipal traumas and conflicts. Alongside this drive-theoretical approach, object and Kleinian theory are also applied to the understanding of collecting. Collecting represents a specific form of object relating and way of handling primary loss trauma, which is different from addiction, compulsion, or perversion. Under certain circumstances collecting can also result in a successful Gestalt or way of life. The paper concludes with a case study showing how collecting develops from a pre-oedipal to a more integrated oedipal mode during the course of the analysis, which is reflected in changes in the transference.

On holding and containing, being and dreaming

Winnicott's concept of holding and Bion's idea of the container-contained are for each of these analysts among his most important contributions to psychoanalytic thought. In this light, it is ironic that the two sets of ideas are so frequently misunderstood and confused with one another. In this paper the author delineates what he believes to be the critical aspects of each of these concepts and illustrates the way in which he uses these ideas in his clinical work. Winnicott's holding is seen as an ontological concept that is primarily concerned with being and its relationship to time. Initially the mother safeguards the infant's continuity of being, in part by insulating him from the 'not-me' aspect of time. Maturation entails the infant's gradually internalizing the mother's holding of the continuity of his being over time and emotional flux. By contrast, Bion's container-contained is centrally concerned with the processing (dreaming) of thoughts derived from lived emotional experience. The idea of the container-contained addresses the dynamic interaction of predominantly unconscious thoughts (the contained) and the capacity for dreaming and thinking those thoughts (the container).

Bodily centered protections in adolescence: An extension of the work of Frances Tustin

In this paper, the author discusses the recurrence of infantile, proto-mental functioning in adolescence mainly in the context of the work of Frances Tustin. She demonstrates, through clinical example, how the tendency to resort to bodily centered and sensation-dominated protections is reactivated on a grand scale when the internal and external physical and psychological changes, brought on in puberty, are felt to be potentially overwhelming. She also demonstrates how, when the capacity for adequate mental and emotional development is stultified, sensation and action once again come to the rescue as the adolescent's way of attenuating anxieties unconsciously experienced as resonating with those unmentalized happenings of early infancy and how the psychoanalytic relationship may be pivotal in setting previously derailed mental and emotional growth back on track.