The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares

This psychometric pilot study aims to evaluate a new multidimensional simple scale, named the nightmare severity index (NSI) - close to the existing insomnia (ISI) and hypersomnia (HSI) severity indexes. The NSI encompasses all main dimensions of nightmare disorder, evaluating four subdimensions: frequency, emotional impact, diurnal impact, and nocturnal impact of nightmares. The NSI was completed by a total of 102 patients. The majority of the population consisted of women (64%) and outpatient individuals (76%) diagnosed with mood disorders such as depression (31%) and bipolar disorder (41%). Comorbidity with post-traumatic stress disorder (PTSD) was prevalent (44%), and psychotropic medications were commonly used (47%). Internal validity analyses indicated that the NSI was well suited for exploratory factor analysis. All items demonstrated satisfactory correlations with the factors, and the questionnaire exhibited good internal consistency (Cronbach's alpha >0.7). Higher NSI scores were observed among individuals experiencing nightmare symptoms considering the DSM-5/ICSD-3 criteria. In summary, the NSI proves to be a promising and valuable tool for clinical practice, demonstrating good acceptability, internal validity, and the ability to assess nightmare severity.

Viral simulations in dreams: The effect of the COVID-19 pandemic on threatening dream content in a Finnish sample of diary dreams

Previous research indicates that the COVID-19 pandemic has affected dreaming negatively. We compared 1132 dreams collected with prospective two-week dream diary during the pandemic to 166 dreams collected before the pandemic. We hypothesized that the pandemic would increase the number of threatening events, threats related to diseases, and the severity of threats. We also hypothesized that dreams that include direct references to the pandemic will include more threatening events, more disease-related threats, and more severe threats. In contradiction with our hypotheses, results showed no differences between pandemic and pre-pandemic samples in the number of threats, threats related to diseases, or severe threats. However, dreams with direct references to the pandemic had more threats, disease-related threats, and severe threats. Our results thus do not suggest a significant overall increase in nightmarish or threatening dream content during the pandemic but show a more profound effect on a minority of dreams.

The Parasomnias

Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.

Longitudinal Study of Early Adversity and Disturbing Dream Frequency: Moderating Role of Early Negative Emotionality

Although disturbing dreams are prevalent in youth and are associated with psychopathology, little is known about their developmental course and risk factors. We aimed to examine the association between early social environment and subsequent disturbing dream frequency across adolescence as moderated by early negative emotionality. Measures of children's early social environment and negative emotionality were collected from the mothers of 410 children (5-42 months old) and measures of disturbing dream frequency directly from the children (13-18 years old). Preliminary steps identified subgroups of families with distinct profiles of social environment using latent variable mixture modeling, and captured changes in disturbing dream frequency using latent growth modeling. Regression and moderation analyses were conducted to test the study objectives. Results showed that the diverse family patterns were best captured by two profiles reflecting adverse and positive social environments and that overall disturbing dream frequency decreased during adolescence. Moderation analyses showed that when early negative emotionality was higher, DD frequency was not only more elevated in an adverse environment, but lower in a positive environment. These results indicate that the development of disturbing dreams is most strongly associated with a combination of individual and environment factors. Our study adds to the literature by refining our conception of individual traits and disturbing dream development and has implications for the prevention of bad dreams, nightmares, and associated psychopathologies.

A systematic review of Nightmare prevalence in children

The purpose of this narrative review was to describe prevalence rates of nightmares and nightmare disorder in school-aged youth according to sample characteristics and methods used to assess nightmares. We searched PsychINFO, PubMed, and CINAHL databases to identify empirical peer-reviewed articles and grey literature published between 2001 and 2021. Sixty-nine studies from 23 countries were included. The prevalence of nightmares was between 1% and 11% in the past week and 25% to 35% in the past month in pediatric developmental samples and between 27% and 57% in the past week and 18%-22% in the past month in psychiatric samples. The prevalence of nightmare disorder was approximately between 3% and 6% in pediatric developmental samples and 10%-12% in psychiatric samples. Nightmare prevalence peaks between ages 10 and 14 then decreases with older age. Generally, prevalence was higher in girls than boys, and one study suggested gender divergence started around age 14. Children's self-reports were higher than parent reports, except in samples with comorbid psychiatric problems where there was more parent-child agreement. Inconsistencies in nightmare definitions and measurement were observed across the literature and indicate a need for standardized measurement of nightmares.

Do Psychedelics Facilitate Emergence of Unconscious Psychological Processes?

Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.

Insomnia symptoms do, but chronotype does not show relevant associations with mental well-being and negative dream experiences

Chronotypes are diversely associated with sleep quality and mental health. Eveningness is generally associated with lower sleep quality and with increased risk for mental health complaints. Along with insomnia symptoms, frequent dysphoric dreams might be key elements of disturbed sleep, and may also indicate psychological imbalance. Our cross-sectional online study aimed to examine whether eveningness can be considered as an independent risk factor of poor mental well-being or whether this association is explained by symptoms of insomnia. Secondly, we examined the associations between eveningness and frequent dysphoric dreaming taking into account the influence of mental well-being and insomnia complaints. Method: We released an online survey with Morningness-Eveningness Questionnaire, Athens Insomnia Scale, General Mental Health, and frequency of dysphoric dreaming: nightmares and bad dreams separately. We analyzed the data of 2077 participants (MAGE = 28.5, SD = 9.6). Eveningness showed a weak but independent association with mental well-being. Additional analyses showed no signs of associations between eveningness and dysphoric dreaming, such as nightmares and bad dreams. The frequency of bad dreams was associated with insomnia complaints and mental well-being, but nightmare frequency was only linked to insomnia symptoms, but not to mental well-being. Insomnia complaints emerged as a more robust factor in poorer mental well-being than the eveningness preference. Eveningness was not associated with dysphoric dreaming. Restoring insomnia might be essential in individuals at risk for mental health complaints.

The role of mindful acceptance and lucid dreaming in nightmare frequency and distress

A theoretical and empirical association between lucid dreaming and mindfulness, as well as lucid dreaming and nightmares has previously been observed; however, the relationship between nightmares and mindfulness has received surprisingly little attention. Here, we present the findings of two studies exploring the relation of nightmare frequency and distress with two components of mindfulness, termed presence and acceptance, as well as lucid dreaming. Study 1 (N = 338) consisted of a low percentage of frequent lucid dreamers whereas Study 2 (N = 187) consisted primarily of frequent lucid dreamers that used lucid dream induction training techniques and meditation. Across studies, nightmare-related variables showed a more robust association with mindful acceptance as opposed to mindful presence. Moreover, individuals with high levels of meditation expertise and practice of lucid dreaming induction techniques reported lower nightmare frequency. Finally, in Study 2, which consisted of frequent lucid dreamers, a positive correlation between lucid dreaming frequency and mindfulness was apparent. The present findings support the notion that wakeful mindfulness is associated with the quality of dreams and extend previous research by suggesting a disentangled role of the two facets of mindfulness in dream variation. This association remains open for experimental manipulation, the result of which could have clinical implications.

Dreaming and Sleep-Related Metacognitions in Patients with Sleep Disorders

Sleep-related metacognitions play a role in the etiology of insomnia and are distressing while falling asleep. Although similar concepts, such as thought suppression, have been studied in the context of dreaming, the relationship between sleep-related metacognitions and more negatively toned dreaming due to stressful pre-sleep experiences has yet to be studied. Overall, 919 patients with various sleep disorders completed the Metacognitions Questionnaire-Insomnia (MCQ-I20), Arousal Disposition Scale (APS), and Pre-Sleep Arousal Scale (PSAS) and kept a sleep diary over seven days eliciting dream recall, nightmare frequency, and the emotional tone of their dreams. The regression analysis showed that the MCQ-I20 (small effect size) and the APS (medium effect size) were associated with nightmare frequency and negatively toned dream emotions. These findings suggest that dysfunctional sleep-related metacognitions that are active prior to sleep are also associated with more negatively toned dreaming and more nightmares—even after controlling for trait arousability. It would be very interesting to study where therapeutic strategies, such as metacognitive therapy explicitly targeting sleep-related metacognition, could also be beneficial with regard to dreams (more positive dreams and fewer nightmares).

The route to recall a dream: theoretical considerations and methodological implications

The goal of this paper is to shed new light on the relation between dream recall and dream experiences by providing a thorough analysis of the process that leads to dream reports. Three crucial steps of this process will be distinguished: dream production (the generation of a conscious experience during sleep), dream encoding (storing a trace of this experience in memory) and dream retrieval (accessing the memory trace upon awakening). The first part of the paper will assess how major theories think about the relationship between dream reports and these distinct steps. The second part will systematise how trait and state factors affecting dream recall-given different theoretical assumptions-might interact with dream production, encoding and retrieval. Understanding how the distinct steps of dream recall can be modulated by different factors is crucial for getting a better grip on how to acquire information about these steps empirically and for drawing methodological conclusions with regard to the tools dream research relies on to collect subjective data about dream experiences. The third part of the paper will analyse how laboratory reports, logs and retrospective scales interact with the different factors that affect the distinct steps leading to dream reports and will argue that prospective methods provide more direct access to data regarding dream production and encoding than retrospective methods, which-due to their inability to provide systematic control over the factors affecting the retrieval stage-screen-off the variability in the production and the encoding of dreams.

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

PURPOSE

The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored.

PATIENTS AND METHODS

For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS).

RESULTS

The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS.

CONCLUSION

Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.

The Characteristics and Prevalence of Dream Bizarreness, Inter-individual Differences and Their Relation to Quality of Life

OBJECTIVE

As existing findings are inconclusive, this paper aims to provide a thorough analysis of the bizarreness of everyday dreams and to explore its relations to the emotional quality of dreams and the dreamers' quality of life.

METHOD

61 women's two week long dream journal (502 dreams) were analyzed using two different kinds of scales in order to capture the bizarre qualities of the reports. The emotional qualities of the dreams were also classified. At the end of the dream log participants filled in the WHOQOL-100 questionnaire to evaluate the different aspects of their quality of life. We examined the frequency and distribution of the distinct forms of distortions in every day dreams by using descriptive statistics. We carried out one-way analysis of variance to analyze the connection between the emotional tone of dreams and their bizarreness. To explore how the inter-individual differences in the qualities of dreams relate to the dreamers quality of life, Spearman correlation and Linear regression were calculated.

RESULTS

According to our findings, although most home reported dreams contain some bizarre elements, they are rarely extremely unrealistic, and there is also a considerable amount of totally mundane dreams. The distortions are not randomly distributed but are mostly related to those parts of the reports which are created during the process of narrative formation. Our findings implicate substantial individual differences regarding the bizarreness and emotional tone of everyday dreams, and both of them correlate with some aspects of the subject's quality of life.

CONCLUSIONS

Those theories should be favored, which can accommodate both unrealistic and totally mundane reports, and can account for the interpersonal differences in this quality of dreams.

A clinical approach to nightmares and bad dreams in cognitive–behavioural therapy

Clinicians trained in cognitive–behavioural therapy (CBT) are frequently not trained to work with dreams. Given the high prevalence and impact of nightmares and bad dreams, empowering CBT therapists to effectively work with these sleep phenomena is crucial to improve therapeutic outcomes. This article briefly outlines a cognitive–behavioural model of dreams and reviews some clinical guidelines for directly and indirectly addressing nightmares and bad dreams in CBT practice.

What goes around comes around: Nightmares and daily stress are bidirectionally associated in nurses

Nurses may experience frequent nightmares due to stressful work environments. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmares, and moderation by post-traumatic stress disorder (PTSD) symptoms. 392 nurses (92% female; 78% White) completed 14 days of sleep diaries to assess previous-day stress severity and nightmare occurrence and severity. PTSD symptoms were assessed at baseline. Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity (b = 0.09, p = 0.033). Nightmare occurrence was associated with greater next-day stress severity (b = 0.15, p < 0.001). Daily stress and nightmare associations were similar for those with and without PTSD symptoms. Nightmares and stress may occur in a bidirectional fashion. Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Studies should explore whether targeting nightmares and stress may improve nurses' health and well-being.

Examining the Factor Structure, Reliability, and Validity of the Disturbing Dreams and Nightmare Severity Index (DDNSI) Consequences Sub-component

Background: The Disturbing Dreams and Nightmares Severity Index (DDNSI) is commonly used when assessing the experience of nightmares. It comprises two parts examining i) chronicity and ii) nightmare consequences. The primary aim of the present study was to explore the dimensional structure of the optional and currently unvalidated nightmare consequences component using exploratory factor analysis. Internal reliability and construct validity were also examined. A secondary aim explored the relationships between nightmare chronicity and perceived consequences with measures of anxiety, depression, stress, self-efficacy, and insomnia.Methods: A cross-sectional survey was conducted with complete data from N = 757 students from six UK-based universities. Participants completed the chronicity and consequences components of the DDNSI, alongside the Sleep Condition Indicator, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale, and General Self-Efficacy Scale.Results: Two nightmare consequences factors emerged; 'Sleep-Interference' (four items; α =.848), and 'Psychosocial Well-being' (six items; α =.946). Significantly moderate correlations were observed between the two emerging factors and the nightmare chronicity component, as well as with insomnia, anxiety, depression, perceived stress, and self-efficacy. Perceived 'Sleep-Interference' (β =-.241) was the strongest predictor of insomnia, and 'Psychosocial wellbeing' was the strongest predictor of anxiety (β =.688) depression (β =.804) perceived stress and lower self-efficacy.Conclusions: The perceived nightmare consequences component of the DDSNI is a multidimensional construct comprising two internally consistent and distinct, but related dimensions. The potential importance of distinguishing between types of perceived nightmare consequences and the associations with mental health outcomes in a student population is highlighted.

Dreaming during COVID-19: the effects of a world trauma

On March 11, 2020, the World Health Organization (WHO) declared a state of health emergency affecting the entire world population. Given the serious practical and psychological difficulties and complications that have been experienced during this period, many scholars have created hypothesis, as a consequence, an increased possibility of developing post-traumatic stress disorder (PTSD) within the general population with significant implications for one's dream activity. Participants in the study were recruited via the instant messaging application 'WhatsApp' for a period of 14 days. The study consisted of three phases: the first phase provided information on the purpose of the research and how to carry it out; in the second phase, each participant, using the Bionian model of dream experience as a focus, was asked to write down dreams, emotions and free connections/associations related to the dream. At the end of the collection, the texts obtained were analysed by means of a qualitative analysis performed with the aid of the MAXQDA software. The study confirms the computational and exploratory analysis of the text carried out in the research of Pesonen et al. (2020), finding also in our sample the presence of the hypothesized clusters going to explain the manifestation of imagery related to COVID-19 also within the dream activity. To confirm this, the nightmare of participant number 6 of the study is reported. The following qualitative research has offered an insight into the traumatic nature of the COVID-19 pandemic, showing how many unmetabolized 'daytime elements' have been reproposed in the dream scenario, recalling the symptomatology of PTSD through the presence of distressing content that affect the quality of sleep and the daily life of the individual.

Sleep paralysis in Italy: Frequency, hallucinatory experiences, and other features

Previous research has found supernatural beliefs about sleep paralysis (SP) to be very prevalent in Italy, with over one third of SP sufferers believing that their SP might have been caused by a supernatural creature known locally as the Pandafeche. The current study further examined features of SP in Italy. All participants had experienced SP at least once in their lifetime. Participants were recruited from the general population (N =  67) in the region of Abruzzo. The Sleep Paralysis Experiences and Phenomenology Questionnaire (SP-EPQ) was orally administered to participants. As hypothesized, we found that Italians from the general population reported high lifetime rates of SP, prolonged duration of immobility during the event, and great fear of the experience (with as many as 42% of SP sufferers fearing that they could die from the experience), all of which were particularly elevated as compared to cultures where there are no such elaborate traditions of SP (e.g., Denmark). In addition, 78% of participants experienced some type of hallucination during their SP. The results we present here suggest that cultural beliefs about SP in Italy (e.g., as being caused by the Pandafeche, as reported elsewhere) potentially can profoundly shape certain aspects of the experience - a type of mind-body interaction.

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Objectives

Nightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.

Methods

A total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI.

Results

Frequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001).

Conclusion

The present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.

The Effects of Sleep Quality on Dream and Waking Emotions

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three ‘Good Sleepers’ (GS) and 27 ‘Poor Sleepers’ (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies.

The Parasomnias

Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.

Effects of nightmares on the cortisol awakening response: An ambulatory assessment pilot study

Previous studies have reported an association between sleep-related factors such as sleep duration, sleep quality and time of awakening with the cortisol awakening response (CAR). Preliminary evidence suggests that frequent nightmares are associated with a blunted CAR. In the present pilot study we investigated the effect of acute nightmares on the CAR and the cortisol profile of the subsequent day using a within-subject ambulatory assessment study design. Thirty healthy volunteers who reported frequent nightmares enrolled in the study. Over a period of 14 days, salivary samples in addition to sleep-related and state variables were collected at home over the day. Salivary profiles of free cortisol and alpha amylase for up to two days following a nightmare were compared to those following a neutral dream. Overall, mood and health were decreased and the CAR was elevated following nightmares compared to neutral dreams. No differences were found for alpha amylase and for all variables over the remaining part of the day. Results suggest that sleep-related factors such as the occurrence of nightmares account for a certain amount of variance observed in the CAR. This has important methodological implications for CAR studies in general and might have even more relevance for studies in clinical populations suffering from chronic sleep disturbances.

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter's Therapy for Insomnia and Nightmares) Study

Background: Firefighters are vulnerable to irregular sleep patterns and sleep disturbance due to work characteristics such as shift work and frequent dispatch. However, there are few studies investigating intervention targeting sleep for firefighters. This preliminary study aimed to develop and test a sleep intervention, namely FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares), which was based on existing evidence-based treatment tailored to firefighters in consideration of their occupational characteristics. Methods: This study implemented a single-group pre-post study design, utilizing an intervention developed based on brief behavior therapy for insomnia with imagery rehearsal therapy components. FIT-IN consisted of a total of three sessions (two face-to-face group sessions and one telephone session). Participants were recruited from Korean fire stations, and a total of 39 firefighters participated. Participants completed a sleep diary for two weeks, as well as the following questionnaires to assess their sleep and psychological factors: insomnia severity index (ISI), disturbing dream and nightmare severity index (DDNSI), Epworth sleepiness scale (ESS), depressive symptom inventory-suicidality subscale (DSI), and Patient Health Questionnaire-9 (PHQ-9). These questionnaires were administered before the first session and at the end of the second session. Results: The FIT-IN program produced improvements in sleep indices. There was a significant increase in sleep efficiency (p < 0.01), and a decrease in sleep onset latency, number of awakenings, and time in bed (p < 0.05), as derived from weekly sleep diaries. In addition, significant decreases were shown for insomnia (p < 0.001) and nightmare severity (p < 0.01). Conclusion: There were significant improvements in sleep and other clinical indices (depression, PTSD scores) when comparing pre-and post-intervention scores. FIT-IN may be a feasible and practical option in alleviating sleep disturbance in this population. Further studies will be needed to ascertain FIT-IN’s effectiveness.

Pandemic Dreams: Network Analysis of Dream Content During the COVID-19 Lockdown

We used crowdsourcing (CS) to examine how COVID-19 lockdown affects the content of dreams and nightmares. The CS took place on the sixth week of the lockdown. Over the course of 1 week, 4,275 respondents (mean age 43, SD = 14 years) assessed their sleep, and 811 reported their dream content. Overall, respondents slept substantially more (54.2%) but reported an average increase of awakenings (28.6%) and nightmares (26%) from the pre-pandemic situation. We transcribed the content of the dreams into word lists and performed unsupervised computational network and cluster analysis of word associations, which suggested 33 dream clusters including 20 bad dream clusters, of which 55% were pandemic-specific (e.g., Disease Management, Disregard of Distancing, Elderly in Trouble). The dream-association networks were more accentuated for those who reported an increase in perceived stress. This CS survey on dream-association networks and pandemic stress introduces novel, collectively shared COVID-19 bad dream contents.

Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder

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.

Bad dreams, bedtime anxiety, and trait anxiety in school-aged children

Background and objectives

Occasional nightmares (distressing dreams that awaking the sleeper) and bad dreams (distressing dreams that do not awaking the sleeper) are very common in children and adolescents. About 5% of children experience frequent nightmares (once a week or more often) and the question arises as to what factors contribute to significant nightmare distress which is basic for diagnosing a nightmare disorder.

Materials and methods

A sample of 624 school-aged children (10–16 years; mean age 12.45 ± 1.33 years) completed a dream questionnaire and an anxiety inventory.

Results

About 11% of the participants reported frequent bad dreams; 3.5% reported frequent bedtime anxieties due to bad dreams. Similar to the findings in adults, distress due to bad dreams was not only related to bad dream frequency but also to trait anxiety—controlling for the direct effect of trait anxiety on bad dream frequency, i.e., bad dream frequency and trait anxiety contributed independently to bedtime anxiety due to bad dreams. In the exploratory part, the cultural background of the children’s parents showed only minor effects on bad dreams.

Conclusion

Similar to nightmare studies in adults, bad dream frequency and trait anxiety contributed independently to bad dream distress. Based on the current diagnostic criteria of the nightmare disorder, it would be interesting to have the opportunity to treat children with significant distress due to nightmares or bad dreams and study the long-term benefit—given that many adult nightmare sufferers reported that their nightmares started in childhood.

Nightmares, Chronotype, Urbanicity, and Personality: An Online Study

Chronotype refers to individual differences in sleep timing ("owls" and "larks") and "eveningness" has been associated with nightmares. However, it has not been tested as to whether neuroticism mediates this relationship. Urbanicity refers to being raised in an urban region and/or currently living in an urban region and is associated with heightened risk for developing mental disorders, and thus might be related to nightmare frequency and nightmare distress. Overall, 2492 persons (1437 women, 1055 men) completed an online survey between 23 March 2015 and 8 April 2015. The mean age of the sample was 47.75 ± 14.41 years. The findings indicate that the previously reported relationship between chronotype and nightmare frequency was mediated by neuroticism and "morningness" was related to higher dream recall compared to persons with a late bedtime preference. Urbanicity was not related to nightmare frequency but to lower nightmare distress, raising the interesting question as to whether beliefs about nightmares might be an important variable that contributes to nightmare distress. Based on the few studies so far, there are still many unresolved questions about the interaction between nightmares, chronotype, and urbanicity.

Disturbing Dreams and Psychosocial Maladjustment in Children: A Prospective Study of the Moderating Role of Early Negative Emotionality

Although frequent disturbing dreams, including bad dreams and nightmares, have been repeatedly associated with poor psychological well-being in adults, considerably less information exists on their psychosocial correlates in children. Recent empirical and theoretical contributions suggest that the association between disturbing dream frequency and psychosocial adaptation in children may differ as a function of children's negative emotionality. The current study assessed the moderating effect of very early negative emotionality (17 months of age) in the relation between disturbing dream frequency and psychosocial maladjustment (i.e., externalizing + internalizing behaviors) in a sample of 173 11-year-old children. Mixed-model analyses revealed that disturbing dream frequency was associated with some internalizing behaviors but that the association between disturbing dream frequency and most externalizing behaviors was moderated by early negative emotionality. The latter result indicates that the relation between disturbing dream frequency and externalizing behaviors was significant in 11-year-old children showing moderate negative emotionality early in life, but particularly strong in those children with high early negative emotionality. Whereas, a moderating effect of early negative emotionality was not found between disturbing dream frequency and internalizing behaviors, the findings highlight the more specific role of early emotional negativity as a developmental moderator for the link between disturbing dreams and externalizing behaviors in children. The results are discussed in light of recent models of disturbed dreaming production.

A psychometric evaluation of the interRAI Child and Youth Mental Health instruments (ChYMH) anxiety scale in children with and without developmental disabilities

BACKGROUND

With 10 to 20% of Canadian children suffering with mental illness, the importance of early identification and accurate assessment systems is clear. Unfortunately, many do not receive the mental health treatment necessary and wait-times for assessment can span up to a year. In response, the interRAI suite of assessments were designed to comprehensively assess early signs of mental health impairments in children from birth to 18 years.

METHODS

This study assesses the psychometric properties of the Anxiety Scale and addresses the identification of anxiety within children diagnosed with intellectual and developmental disabilities (IDD); a commonly underrepresented sample in mental health psychometric studies. Data was collected from children aged 4-18 years in three different samples.

RESULTS

Results indicated reliable internal consistency and factor structure, as well as moderate-to-strong convergent validity.

CONCLUSIONS

We conclude that the Anxiety Scale exhibits psychometric qualities which demonstrate its clinical utility for use within a child sample, as well as in children with IDD. The findings provide support to a larger body of research which show consistent psychometric rigour of the interRAI measures.

Stability of nightmare frequency and its relation to neuroticism: A longitudinal study

Models of nightmare aetiology postulate an interaction between trait and state factors. However, most of the studies that support these models have been cross-sectional and longitudinal studies are scarce. The present data were obtained from N = 888 participants completing two online dream studies carried out independently with the same online panel 2 years apart. Nightmare frequency declined over the 2-year period and these changes were related to changes in neuroticism. The effect of current psychopathology (state aspect) on nightmare frequency was significant but much smaller compared to the effect of previously measured nightmare frequency (trait aspect) and, thus, the study provided empirical evidence for diathesis-stress models. Future longitudinal studies should take a closer look at life events and other factors that increase and/or decrease nightmare frequencies.

My Dream, My Rules: Can Lucid Dreaming Treat Nightmares?

Nightmares are defined as repeated occurrences of extremely dysphoric and well-remembered dreams that usually involve subjective threats to survival, security, or physical integrity. Generally, they occur during rapid eye movement sleep (REMS) and lead to awakenings with distress and insufficient overnight sleep. Nightmares may occur spontaneously (idiopathic) or as recurrent nightmares. Recurrent nightmares cause significant distress and impairment in occupational and social functioning, as have been commonly observed in post-traumatic stress disorder, depression and anxiety. By contrast, during lucid dreaming (LD), subjects get insight they are dreaming and may even control the content of their dreams. These features may open a way to help those who suffer from nightmare disorder through re-significations of the dream scene, i.e., knowing that they are dreaming and having control over their dream content. Thus, lucid dreamers might be able to render nightmares normal dreams, thereby assuring a restoring sleep. The aim of the present study is to review the existing literature of the use of LD as an auxiliary tool for treatment of nightmares. We conducted a careful literature search for eligible studies on the use of LD treatment for nightmares. We observed that whereas LD may be a feasible aid in the treatment of patients with nightmares through minimizing their frequency, intensity and psychological distress, the available literature is still scarce and does not provide consistent results. We conclude therefore that more research is clearly warranted for a better estimation of the effective conductance and therapeutic outcome of LD treatment in clinical practice.

Predicting the affective tone of everyday dreams: A prospective study of state and trait variables

Although emotions are reported in a large majority of dreams, little is known about the factors that account for night-to-night and person-to-person variations in people’s experience of dream affect. We investigated the relationship between waking trait and state variables and dream affect by testing multilevel models intended to predict the affective valence of people’s everyday dreams. Participants from the general population completed measures of personality and trauma history followed by a three-week daily journal in which they noted dream recall, valence of dreamed emotions and level of perceived stress for the day as well as prior to sleep onset. Within-subject effects accounted for most of the explained variance in the reported valence of dream affect. Trait anxiety was the only variable that significantly predicted dream emotional valence at the between-subjects level. In addition to highlighting the need for more fine-grained measures in this area of research, our results point to methodological limitations and biases associated with retrospective estimates of general dream affect and bring into focus state variables that may best explain observed within-subject variance in emotions experienced in everyday dreams.

Nightmare experience and family relationships in healthy volunteers and nightmare disorder patients

BACKGROUND

Nightmares are associated with parental bonding styles and various psychiatric disorders, but the exact connections between different nightmare experience features and family relationships in healthy volunteers and nightmare disorder patients are still unclear.

METHODS

We therefore invited 62 nightmare disorder patients and 135 healthy volunteers to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Family Relationship Questionnaire (FRQ), and the Plutchik - van Praag Depression Inventory (PVP).

RESULTS

Besides the higher nightmare frequency and the higher PVP and four NEQ scale scores, the nightmare disorder patients had higher scores of FRQ Paternal Abuse, and lower ones of General Attachment, Maternal Encouragement, Maternal Freedom Release, and Paternal Freedom Release. The PVP was correlated with some NEQ and FRQ scales in both healthy volunteers and patients, and it functioned as a mediator between Physical Effect and Maternal Dominance in patients. Regarding predicting NEQ by FRQ, Paternal Abuse predicted Physical Effect, Maternal Dominance predicted Physical Effect and Horrible Stimulation, General Attachment predicted Horrible Stimulation (-) in healthy volunteers; Maternal Dominance predicted Physical Effect, Meaning Interpretation, and Horrible Stimulation, Paternal Freedom Release predicted Physical Effect (-), and Paternal Dominance predicted Meaning Interpretation and nightmare frequency in patients.

CONCLUSIONS

Our study has demonstrated that the inappropriate family relationships were linked with different aspects of nightmare experience, especially in nightmare disorder patients.

Exploring Thematic Nightmare Content and Associated Self-Harm Risk

Nightmares have been shown to be robust predictors of self-harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self-harm risk. This study explored associations of thematic nightmare content with history of self-harm, and risk of self-harm phenomena the morning following a nightmare. A mixed-method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi-square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self-harm history, and risk of self-harm phenomena following a nightmare. "Powerlessness to Change Behavior" was associated with a history of self-harm engagement, whereas "Financial Hardship" indicated reduced risk. Themes were not significantly associated with increased risk of self-harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self-harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self-harm risk is presently lacking. Replication with increased power is recommended.

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.

The Effects of an Internet-Based Imagery Rehearsal Intervention: A Randomized Controlled Trial

BACKGROUND

Nightmares are extremely dysphoric dreams, which are prevalent and associated with psychological strain. This study investigated (a) the efficacy of an internet-based imagery rehearsal therapy (IRT), (b) the role of imagery rescription, and (c) the role of guidance during internet-based IRT.

METHODS

A total of 127 patients suffering from mainly idiopathic nightmares were randomly assigned to 1 of 2 IRT internet-based groups (guided IRT; unguided IRT) or to 1 of 2 active control groups (frequency control group; narrative control group).

RESULTS

IRT was more effective than a nightmare frequency control condition with respect to nightmare frequency and nightmare distress. Compared to the narrative control group, IRT was only superior in improving nightmare distress but not in nightmare frequency because the narrative control group also improved regarding nightmare frequency. Guidance by a nightmare coach did not affect efficacy, compliance, or dropout.

CONCLUSION

Internet-based IRT seems to be an effective treatment even when offered with minimal guidance by a nightmare coach. Describing the nightmare narrative in detail already decreased nightmare frequency. However, with regard to inducing decreases in nightmare frequency and nightmare distress, IRT was superior to the narrative control group. The results are discussed with reference to the mastery hypothesis.

Linking psychological need experiences to daily and recurring dreams

The satisfaction of individuals’ psychological needs for autonomy, competence, and relatedness, as conceived from a self-determination theory perspective, is said to be conducive to personal growth and well-being. What has been unexamined is whether psychological need-based experiences, either their satisfaction or frustration, manifests in people’s self-reported dream themes as well as their emotional interpretation of their dreams. A cross-sectional study (N = 200; M age = 21.09) focusing on individuals’ recurrent dreams and a three-day diary study (N = 110; M age = 25.09) focusing on daily dreams indicated that individuals experiencing psychological need frustration, either more enduringly or on a day-to-day basis, reported more negative dream themes and interpreted their dreams more negatively. The contribution of psychological need satisfaction was more modest, although it related to more positive interpretation of dreams. The discussion focuses on the role of dreams in the processing and integration of psychological need-frustrating experiences.

Arousal in Nocturnal Consciousness: How Dream- and Sleep-Experiences May Inform Us of Poor Sleep Quality, Stress, and Psychopathology

The term "sleep experiences," coined by Watson (2001), denotes an array of unusual nocturnal consciousness phenomena; for example, nightmares, vivid or recurrent dreams, hypnagogic hallucinations, dreams of falling or flying, confusional arousals, and lucid dreams. Excluding the latter, these experiences reflect a single factor of atypical oneiric cognitions ("general sleep experiences"). The current study is an opinionated mini-review on the associations of this factor-measured with the Iowa sleep experiences survey (ISES, Watson, 2001)-with psychopathological symptoms and stress. Findings support a strong relation between psychological distress and general sleep experiences. It is suggested that that they should be viewed as a sleep disturbance; they seem to represent involuntary intrusions of wakefulness into sleep, resulting in aroused sleep. These intrusions may stem from excessively thin boundaries between consciousness states (e.g., "transliminality"), or, conversely, they may follow an attempt at disconnecting mental elements (e.g., dissociation), which paradoxically results in a "rebound effect." The extent to which unusual dreaming is experienced as intrusive, rather than controlled, may explain why general sleep experiences are related to psychopathology, whereas lucid dreams are related to psychological resilience. In conclusion, the exploration of the interplay between psychopathology and sleep should be expanded from focusing almost exclusively on quantitative aspects (e.g., sleep efficiency, latency) to including qualitative conscious experiences which may reflect poor sleep quality. Taking into account nocturnal consciousness-including unusual dreaming and permeable sleep-wake boundaries-may unveil rich information on night-time emotional states and broaden our definition of poor sleep quality.

Waking-hour cerebral activations in nightmare disorder: A resting-state functional magnetic resonance imaging study

AIM

The purpose of the current study was to explore the cerebral areas involved in nightmare disorder.

METHODS

Fifteen nightmare disorder patients and 15 healthy volunteers were invited to undergo resting-state functional magnetic resonance imaging and to complete the Nightmare Experience Questionnaire.

RESULTS

The nightmare disorder patients scored higher on the Physical Effect and Horrible Stimulation scales, had higher values of regional homogeneity in clusters within the left anterior cingulate cortex and right inferior parietal lobule, and lower regional homogeneity values within the left superior and inferior frontal gyri and bilateral middle occipital gyri. Physical Effect was negatively correlated with regional homogeneity values in anterior cingulate cortex and inferior parietal lobule in the nightmare disorder group, and was positively correlated with regional homogeneity value in the inferior frontal gyrus in the healthy control group.

CONCLUSION

To our best knowledge, this is the first neuroimaging study on nightmare disorder, and we have characterized the cerebral activities underlying altered hyperarousal and emotion regulation in nightmare disorder at resting-state.

Nightmare frequency in last trimester of pregnancy

Background

Pregnancy-related dreams are often found in pregnant women but also the number of negatively toned dreams seems to be increased in this challenging phase of a woman’s life.

Methods

Nightmare frequency and subjectively experienced stress was elicited via questionnaires. The mothers-to-be were approached during their application visit about 4–8 weeks prior to delivery in three obstetric hospitals. The present analysis included 406 women aged 16–40 years in the last trimester of their pregnancy. Women with severe somatic illnesses and/or psychiatric disorders were excluded. The representative sample included 496 women (age range: 14–93 years.).

Results

The findings clearly indicate that pregnant women report nightmares more often compared to a representative sample and that nightmare frequency is closely related to subjectively experienced stress during daytime. Moreover, baby-related dreams were correlated with nightmare frequency but not with day-time stress.

Conclusions

Future studies should investigate the prevalence of nightmare disorders in pregnancy and study whether brief interventions like Imagery Rehearsal Therapy are beneficial for pregnant women suffering from nightmares.

The Relation of Fantasy Proneness, Psychological Absorption, and Imaginative Involvement to Nightmare Prevalence and Nightmare Distress

The present study prospectively investigated the relationship between nightmare prevalence, nightmare distress, and waking imaginative involvement. One hundred and sixteen individuals completed self-report indices of fantasy proneness, psychological absorption, and daydreaming as well as a sleep and dreaming questionnaire and a nightmare distress measure. Participants then kept a dreaming and nightmare log for 21 consecutive nights. As predicted, both nightmare prevalence and nightmare distress were associated with higher levels of fantasy proneness, psychological absorption, and a guilty-dysphoric daydreaming style but not with positively-toned daydreams or a highly distractible daydreaming style. Further, these results were not due to higher levels of overall dream recall. Last, these effects were additive as high scores on either fantasy proneness or absorption added significantly higher incremental validity to the prediction of nightmare prevalence and distress than just from the dysphoric daydreaming measure alone. The results are discussed within the context of emerging etiological theories of nightmare production.