The use of dreams in psychotherapy: a survey of psychotherapists in private practice

Since the publication of Sigmund Freud's The Interpretation of Dreams, dream interpretation has been a standard technique often used in psychotherapy. However, empirical studies about the frequency of working on dreams in therapy are lacking. The present study elicited, via a self-developed questionnaire, various aspects of work on dreams applied by psychotherapists in private practice. The findings indicate that dreams were often used in therapy, especially in psychoanalysis. In addition, a significant relationship was found between the frequency of the therapists' working on their own dreams and frequency of work on dreams in therapy. Because work on dreams was rated as beneficial for the clients, further studies investigating the effectiveness and the process of working on dreams will be of interest.

The problem of dream length in analysis of content

The present study investigated the linear as well as nonlinear relationships between scores on selected dream content scales and dream length. Analysis indicated that biases due to control solely for the linear components are almost negligible.

Emotions in diary dreams

Even though various investigations found a preponderance of negative emotions in dreams, the conclusion that human dream life is, in general, negatively toned is limited by several methodological issues. The present study made use of three different approaches to measure dream emotions: dream intensity rated by the dreamer, intensity rated by a judge, and scoring of explicitly mentioned emotions (Hall & Van de Castle, 1966). Results indicate that only in the case of external raters' estimates do negative emotions outweigh the positive ones; but in the case of self-ratings (i.e., those made by the dreamer himself/herself), the ratio was balanced. Analyses showed that this is mainly due to the underestimation of positive emotions in the external ratings. Additionally, a positive correlation was found between the intensity of dream emotions and dream recall frequency, whereas gender differences were nonsignificant as regards the emotional tone of diary dreams.

Is the ratio of male and female dream characters related to the waking-life pattern of social contacts?

The present study investigated the relationship between the sex ratio of dream characters and the person's waking-life pattern of social contacts. Results partly confirm the continuity between waking and dreaming.

Dreaming and insomnia: dream recall and dream content of patients with insomnia

The present study investigated dream recall frequency and dream content of patients with insomnia in comparison to healthy controls. Patients' dream recall frequency was elevated, due mainly to their heightened frequency of nocturnal awakenings. Dream content seems to reflect waking life stressors found in these patients, i.e. dream emotions were more negative and dreams were characterized by themes of depression, 'negatives' in self-description and health themes. Patients taking antidepressants showed lower dream recall frequency than patients without any medication; benzodiazepine intake, however, did not affect dream recall frequency. Both drug groups reported more positively toned dreams than drug-free patients. It is suggested that future studies should use more dreams per subject in order to reduce error variance of the dream content measures and more detailed measures of waking life stress.

[Sex specific differences of nightmares in students]

In regard of the literature reporting gender differences in dream life of adults and children the present study investigated anxiety dreams in a sample of 624 school-aged children (10 to 16 years). Girls reported a heightened frequency of anxiety dreams, especially after the age of 14 years. Gender differences in dream content were found, too. Boys more often dreamt of monsters and big animals whereas girls' dreams were dominated by humans and small animals as aggressors. Overall the findings support the hypothesis that gender specific socialization is reflected in dreams. Further research may concentrate on topics such as the relationship between anxiety dream frequency and problem-solving skills or the treatment of nightmares with imagery rehearsal.

Stability and variability of dream content

The present study investigated the stability and variability, respectively, of selected dream content measures derived from diary dreams. The within-subject correlations were small when dream length was controlled. To obtain sufficient reliability for all scales dream series of 20 dreams or more would be necessary.

[Dream contents of sleep disordered patients]

The present study investigates dreams reports of patients with sleep disorders. Whereas, the findings scarcely showed specific dream contents for different sleep disorders, e.g. problematic dreams in insomniacs, breathing-related dreams in sleep-apnea-patients, a remarkable relationship between waking life and dream contents did occur. Private problems and occupational stress are reflected in dreams by means of increased negative feelings, aggression and occupational themes. The results suggest that dreams can be made use of in psychological invention methods in sleep disorders, e.g. stress management.

Ratio of male and female characters in a dream series

The present study investigated the change in gender ratio of dream characters in relation to the dreamer's environment in waking-life and found a preponderance of male characters in the subject's dream while living in a 'male' environment which was not present while living in a 'female' environment. The results support the continuity hypothesis of dreaming and stress the importance of situational factors rather than personality factors in the explanation of the gender ratio of dream characters.

[Sleep apnea syndrome and cerebral lesions--a prospective MRI study]

It seems well known that sleep apnea syndrome (SAS) is associated with cardiovascular complications, inclusive myocardial infarctions. Our study aimed to test the hypothesis that patients suffering from cerebral SAS have more cerebrovascular findings resp. brain infarctions than a matched control group. We analysed prospectively MRI studies of 14 patients with SAS and controls without SAS in respect of specific and nonspecific vascular cerebral lesions including atrophic changes of the brain. In contrast to our expectations, the rate of SAS-associated ischemic brain lesions is unimportant and not significantly different from age-associated brain lesions in controls. The rate of brain infarctions is distinctly different from that of myocardial infarctions. The outcomes are discussed with regard to new results of "ischemia-induced" ischemic tolerance on different tissues.

Cellular association of antiproteases in lavages from ventilated preterm human neonates

Lung antiprotease activity is routinely assayed in the supernatant of bronchoalveolar lavage fluid (BALF). In this study the cellular fraction of lavages was also analyzed. Functionally active acid-resistant inhibitors with molecular masses characteristic of the mucus proteinase inhibitor (MPI, 14 kDa) and elastase-specific inhibitor (ESI, 7 kDa) were demonstrated by gel chromatography. Immunocytochemical studies of cells obtained at various postnatal time points from lavages of 10 premature infants with chronic lung disease showed that the inhibitors were confined to neutrophils and macrophages. At each time point, about 70% and 21% of these cells, respectively, stained positively. The polyclonal antibodies usually used to detect MPI did not distinguish between MPI and ESI. Because of this cross reactivity, it was not possible to differentiate between MPI and ESI. Analysis with reverse transcriptase-polymerase chain reaction (RT-PCR) of cells from lavages and of nucleated cells isolated from the peripheral blood showed the production of ESI only, but not of MPI. Nevertheless, MPI can associate with neutrophils and macrophages, as was shown in binding studies with the recombinant protein. These data suggest that when assaying bronchoalveolar lavages (BALs) for these antiproteases in the supernatant only, the total pool of inhibitors may be underestimated.

Autogenic training and dream recall

The present study has investigated the relationship between Autogenic Training and dream recall for 112 participants in 16 beginning courses of 10 wk. Analyses confirmed the hypothesis that learning and practicing this relaxation technique enhanced dream recall.

[Dream recall and sleep disorders]

The present study investigated the relationship between dream recall and sleep disorders. The sample comprised 762 patients who were diagnosed in the sleep laboratory. In the course of the examination they completed the sleep questionnaire SF-B (Görtelmeyer 1986). The results showed a heightened dream recall frequency (DRF) in insomniacs and patients with myoclonia. This result as well as the findings in the control group supports the arousal-retrieval model of dream recall (Koulack u. Goodenough 1976) which emphasizes the importance of nocturnal awakenings. However, this model seems only to be valid for males. In females, DRF is mainly influenced by emotional stress which is best explained by the salience hypothesis of Cohen and MacNeilage (1974). They pointed out that intensive dream emotions lead to high recallability of dream experience. The data gives evidence to the hypothesis of Ermann et al. (1993, 1994) which states that reduced DRF in terms of unsuccessful dream work is accompanied by frequent nocturnal awakenings. DRF of patients with sleep apnea syndrome did not differ from DRF in healthy controls. In addition, sleep apnea parameters did not correlate substantially with DRF. The finding that insomniacs reported more negatively toned dreams in comparison to persons who were examined for sleep apnea but did not showed a pathological apnea index. This may be an hint to increased emotional stress in this patient group. To summarize, the results are promising in clarifying the relationship between sleep disorders and dream life. The next step is to investigate dream reports of these patients by means of content analysis.

[Nightmares in children]

Childhood nightmares are till today a very common phenomenon. The highest prevalence seems to be at about age six, decreasing strongly with age and no gender-specific differences in prevalence rates can be pinpointed for sure. The most frequently occurring nightmare themes are "Being chased", followed by dreams of "Falling" and those concerning, "Loss of close persons". As reasons for such dreams such factors as genetic influence, trait anxiety, traumatic experiences have been assumed, whereas a more comprehensive explanation model-which would take developmental issues into consideration-unfortunately does not yet exist. Numerous case studies have confirmed that childhood nightmares are easily treatable, especially where such children are encouraged to confront and cope with their anxiety. Further research such as longitudinal studies that would examine dream contents and children's waking-life experiences would be useful for a better overall understanding of the nightmare phenomenon and the causes behind their occurrence. In addition, it seems to be useful to inform parents, child caretakers, teachers and children about the simple methods in dealing with nightmares.

[Dream recall in depressed patients]

The present paper reviews the literature on dream life and dream recall in depressives. Most often the depressive recall fewer dreams than healthy controls. This finding was confirmed by the present study. The hypothesis that the reduction of dream recall is caused by cognitive impairment was partly supported. Other results of the study, positive correlations between dream recall and age or duration of illness, need further study.

Dream recall and visual memory

The present study estimated correlations for 50 subjects among frequency of dream recall, length of dream report, and visual memory. Whereas the results confirmed the previously found relationship between frequency of dream recall and visual memory, influence of visual memory on length of dream report was not found.

Dream length and creativity: an opposite finding

The present study investigated the relation between dream length and verbal creativity for 32 subjects who were given a verbal creativity test and also kept a dream diary over a 2-wk. period. Subjects with high verbal creativity scores reported significantly shorter dreams. This may indicate that other factors influence the dream report's length, including visual memory.

The cholinergic REM induction test with RS 86 after scopolamine pretreatment in healthy subjects

A shortened latency of rapid eye movement (REM) sleep is one of the most stable biological abnormalities described in depressive patients. According to the reciprocal interaction model of non-REM and REM sleep regulation, REM sleep disinhibition at the beginning of the night in depression is a consequence of heightened central nervous system cholinergic transmitter activity in relation to aminergic transmitter activity. A recent study has indicated that muscarinic supersensitivity, rather than quantitatively enhanced cholinergic activity, may be the primary cause of REM sleep abnormalities in depression. The present study tested this hypothesis by treating healthy volunteers for 3 days with a cholinergic antagonist (scopolamine) in the morning, in an effort to induce muscarinic receptor supersensitivity. On the last day of scopolamine administration, RS 86, an orally active cholinergic agonist, was administered before bedtime to test whether this procedure would induce sleep onset REM periods. Whereas scopolamine treatment tended to advance REM sleep and to heighten REM density in healthy controls in comparison to NaCl administration, the additional cholinergic stimulation did not provoke further REM sleep disinhibition. This result underlines the need to take a hypofunction of aminergic transmitter systems into account in attempts to explain the pronounced advance of REM sleep typically seen in depressives.

Investigations of morning and laboratory dream recall and content in depressive patients during baseline conditions and under antidepressive treatment with trimipramine

REM sleep abnormalities like shortened REM (rapid eye movement) latency, prolongation of the first REM period and heightening of REM density often found in patients with a major depression have prompted an increasing number of studies investigating the neurobiology and neurophysiology of REM sleep in depressive patients, as well as in healthy humans and animals. On the other hand, since the early 1970s investigation of the psychological concomitant of REM sleep, i.e., dreaming, in depressive patients has been extremely sparse. The present study aimed at investigating morning and laboratory dream recall and content in patients with a major depressive disorder to shed more light on this neglected area. In short, morning as well as laboratory dream recall in depressive inpatients was drastically reduced. The low number of scorable dream reports collected did not reveal a heightened incidence of "masochistic" or "negative" content, indeed were rather mundane. In contrast, depressive outpatients (probably less depressed) had a higher rate of morning dream recall. Interestingly, antidepressive treatment with trimipramine (an antidepressant which does not suppress REM sleep) led to a positive influence on patients' mood that was paralleled by a change of dream mood in a positive direction.