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Garriques VR, Dhruve DM, Nadorff MR. Nightmare Disorder. Sleep Med Clin 2024; 19:111-119. [PMID: 38368059 DOI: 10.1016/j.jsmc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
This article presents a comprehensive review of nightmare disorder, covering diagnosis, treatment approaches, guidelines, and considerations. It begins with an introduction, defining the disorder and addressing its prevalence and psychosocial implications. The article explores assessment tools for diagnosis and then delves into psychological and pharmacologic treatment modalities, examining their efficacy and side effects. Considerations for optimizing therapeutic outcomes are highlighted, including medication versus psychotherapy, co-morbidities, cultural implications, and the use of technology and service animals. The review concludes by offering key recommendations for effective treatment and clinical care for individuals with nightmare disorder.
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Affiliation(s)
- Victoria R Garriques
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Deepali M Dhruve
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA.
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2
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Yount G, Taddeo S, Stumbrys T, Kriegsman M, Wahbeh H. Trends in waking salivary alpha-amylase levels following healing lucid dreams. Front Psychol 2024; 15:1347499. [PMID: 38298517 PMCID: PMC10828844 DOI: 10.3389/fpsyg.2024.1347499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Salivary alpha-amylase (sAA) is considered a marker of autonomic nervous system activity in stress research, and atypical waking sAA responses have been reported for traumatized individuals. Lucid dreams, characterized by a dreamer's awareness of their dream state while remaining asleep, have shown promising preliminary evidence of their potential to enhance mental health. This study's objective was to evaluate sAA in relation to healing lucid dreams. Methods Participants experiencing PTSD symptoms attended a six-day workshop delivered via live video designed to teach techniques for transforming trauma through dreamwork and dream lucidity. Participants (n = 20) collected saliva samples each morning, immediately upon awakening (Time 1) and 30 min afterward (Time 2). sAA levels were determined by enzymatic assay, and the waking sAA slope was calculated as the difference of Time 2 minus Time 1. Participants completed dream reports each morning, with a dream classified as a 'healing lucid dream' when they reported attaining lucidity and remembered their intention to manifest a healing experience within the dreamscape. Results Of eight participants experiencing healing lucid dreams, four were able to provide usable saliva samples. Statistical tests on these four participants were not significant because of low power. However, nonsignificant positive associations were observed between experiencing more healing lucid dreams and increased waking sAA slope. Conclusion The results did not reveal a consistent effect of healing lucid dreams on waking sAA slope. Identifying meaningful patterns in this relationship will require larger samples and more stringent control over saliva collection procedures in future studies.
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Affiliation(s)
- Garret Yount
- Institute of Noetic Sciences, Novato, CA, United States
| | - Sitara Taddeo
- Institute of Noetic Sciences, Novato, CA, United States
| | - Tadas Stumbrys
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Helané Wahbeh
- Institute of Noetic Sciences, Novato, CA, United States
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3
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Gott JA, Stücker S, Kanske P, Haaker J, Dresler M. Acetylcholine and metacognition during sleep. Conscious Cogn 2024; 117:103608. [PMID: 38042119 DOI: 10.1016/j.concog.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/03/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023]
Abstract
Acetylcholine is a neurotransmitter and neuromodulator involved in a variety of cognitive functions. Additionally, acetylcholine is involved in the regulation of REM sleep: cholinergic neurons in the brainstem and basal forebrain project to and innervate wide areas of the cerebral cortex, and reciprocally interact with other neuromodulatory systems, to produce the sleep-wake cycle and different sleep stages. Consciousness and cognition vary considerably across and within sleep stages, with metacognitive capacity being strikingly reduced even during aesthetically and emotionally rich dream experiences. A notable exception is the phenomenon of lucid dreaming-a rare state whereby waking levels of metacognitive awareness are restored during sleep-resulting in individuals becoming aware of the fact that they are dreaming. The role of neurotransmitters in these fluctuations of consciousness and cognition during sleep is still poorly understood. While recent studies using acetylcholinesterase inhibitors suggest a potential role of acetylcholine in the occurrence of lucid dreaming, the underlying mechanisms by which this effect is produced remains un-modelled and unknown; with the causal link between cholinergic mechanisms and upstream psychological states being complex and elusive. Several theories and approaches targeting the association between acetylcholine and metacognition during wakefulness and sleep are highlighted in this review, moving through microscopic, mesoscopic and macroscopic levels of analysis to detail this phenomenon at several organisational scales. Several exploratory hypotheses will be developed to guide future research towards fully articulating how metacognition is affected by activity at the acetylcholine receptor.
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Affiliation(s)
- Jarrod A Gott
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sina Stücker
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
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Ouchene R, El Habchi N, Demina A, Petit B, Trojak B. The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. L'ENCEPHALE 2023; 49:525-531. [PMID: 37005191 DOI: 10.1016/j.encep.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Nightmares can be defined as "an unpleasant dream with anxiety and oppression". They represent a symptom possibly leading to serious psychiatric and physical consequences. It occurs to 2% to 8% of the general population. Lucid dreaming therapy (LDT) is an interesting upcoming psychotherapy for the treatment of nightmares. The aim of this study was to evaluate the efficacy of LDT in the treatment of nightmares in adults and children. METHODS We performed a systematic review of the literature, based on the Cochrane organisation's methodology. We explored the PubMed, Cochrane library, PsycINFO via Ovid and Embase databases and clinical trial registries (CTR), namely clinicaltrials.gov, EU clinical trials and the WHO clinical trials registry platform. RESULTS Four randomized controlled trials (RCT), 2 case series and 5 case reports were included. Most of the included studies found LDT effective in reducing nightmare frequency among adults with chronic and recurring nightmares. We did not identify any reports in children. CONCLUSIONS Despite a limited internal validity for the included studies, these first results are encouraging. Nonetheless, larger and more rigorous studies would allow to better assess the utility of LDT for nightmares.
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Affiliation(s)
- R Ouchene
- Centre Hospitalier La Chartreuse, 21000 Dijon, France.
| | - N El Habchi
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - A Demina
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - B Petit
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - B Trojak
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France; Université de Bourgogne Franche-Comté, UMR Inserm 1093, CAPS, Dijon, France
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5
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Ableidinger S, Holzinger B. Sleep Paralysis and Lucid Dreaming-Between Waking and Dreaming: A Review about Two Extraordinary States. J Clin Med 2023; 12:jcm12103437. [PMID: 37240545 DOI: 10.3390/jcm12103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sleep paralysis and lucid dreams are two states of consciousness that are connected to REM sleep but are defined by higher awareness in contrast to regular REM sleep. Despite these similarities, the two states differ widely in their emotional tone and their perceived controllability. This review aims to summarize the current research containing sleep paralysis and lucid dreams. However, given the sparsity of the research, one single topic cannot be chosen. METHODS Articles containing both lucid dreams as well as sleep paralysis were searched for in the following databanks: MEDLINE, Scopus, Web of Science, PsycInfo, PsycArticles, and PSYNDEX. Further, citations of the found papers were examined. RESULTS 10 studies were included in the review. Most of the studies were surveys, but there was also a case study, a randomized trial, and an observational EEG study. The numbers of participants ranged from a single participant in the case study to 1928 participants in a survey. The main findings were that correlations between sleep paralysis and lucid dreaming were positive and significant in most of the studies. CONCLUSIONS There is a connection between lucid dreaming and sleep paralysis. However, research is still very limited and diverse in the methodologies used. Future research should build standardized methods for examining the two phenomena.
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Affiliation(s)
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, 1180 Vienna, Austria
- Sleep Coaching, Medical University Vienna, 1090 Vienna, Austria
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6
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Gill P, Fraser E, Tran TTD, De Sena Collier G, Jago A, Losinno J, Ganci M. Psychosocial treatments for nightmares in adults and children: a systematic review. BMC Psychiatry 2023; 23:283. [PMID: 37085821 PMCID: PMC10122409 DOI: 10.1186/s12888-023-04703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/21/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND As nightmares may be a risk factor for, or symptom of, multiple psychological disorders, some researchers suggest that nightmares should be screened, diagnosed, and treated. Treatments for nightmares include trauma-focused Cognitive Behavioural Therapy and Image Rehearsal Therapy, and pharmacological interventions such as prazosin and nitrazepam. As recent research has put into question our current understanding of treatment efficacy, there is a need to systematically review findings related to the effectiveness of nightmare treatments to inform best practice. The current review assessed the efficacy of psychosocial treatments of nightmare in all cohorts. METHODS A systematic search of four databases for peer reviewed journal articles from 2000 onwards produced 69 (35 RCTs, 34 non-RCTs) eligible articles that underwent narrative synthesis. RESULTS The results provide strong evidence for exposure and image rehearsal treatments for the reduction of nightmare frequency, severity, and distress, in civilian, military, idiopathic, and posttraumatic stress disorder (PTSD) cohorts. There is emerging evidence that self-guided and brief treatment modalities offer efficient and effective treatment options. There is an urgent need for clinical trials of treatment effectiveness in children. CONCLUSIONS The results suggest that treatments for nightmares are most effective when they facilitate a sense of control or mastery by directly targeting the nightmare content and/or the client's emotional responses to the nightmare content. TRIAL REGISTRATION A review protocol was registered with PROSPERO (CRD42020204861).
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Affiliation(s)
- Peter Gill
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia.
| | - Emily Fraser
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Thong Thai Diep Tran
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Gabriel De Sena Collier
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Andrew Jago
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Joe Losinno
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Michael Ganci
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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7
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Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med 2023; 19:499-509. [PMID: 36468650 PMCID: PMC9978420 DOI: 10.5664/jcsm.10374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample of adult sleep clinic outpatients. A secondary objective was to assess whether treatment produces improvements in daytime fatigue/sleepiness, perceived cognition, mood, and depression/anxiety/stress, as well as functional impairment in work and leisure activities. METHODS This was a randomized controlled trial with CBTp and self-monitoring control conditions. Participants were 19 adults with a DSM 5 parasomnia disorder who received individual CBTp virtually from their homes. CBTp consisted of psychoeducation, sleep hygiene and safety instructions, relaxation training, parasomnia techniques, and relapse prevention in a 6-week manualized, structured program. RESULTS Using a repeated measures analysis of variance model, and relative to a self-monitoring control condition, results showed that CBTp produced statistically significant improvements in parasomnia frequency, severity, nocturnal activity, and sleep efficiency. There was a trend toward reduced sleep-onset latency and improved work and social adjustment. Of treated participants, 100% rated themselves as improved at study conclusion. CONCLUSIONS Implications of these findings are that cognitive behavioral interventions for parasomnias are effective in lessening parasomnias. More investigation into this type of treatment is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Impact of Cognitive Behavioral Therapy on Parasomnias; URL: https://clinicaltrials.gov/ct2/show/NCT04633668; Identifier: NCT04633668. CITATION Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med. 2023;19(3):499-509.
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Affiliation(s)
- Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dale Dirkse
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eleni Giannouli
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda McQuarrie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Tan S, Fan J. A systematic review of new empirical data on lucid dream induction techniques. J Sleep Res 2022; 32:e13786. [PMID: 36408823 DOI: 10.1111/jsr.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022]
Abstract
Lucid dreams are defined as dreams in which the dreamers are aware of the fact that they are dreaming as dreams continue. It has been ~12 years since the last review of the efficiency of lucid dream induction techniques was conducted. Hence, the present study aimed to review the lucid dream induction techniques published in the past decade. The second aim was to propose a modified classification for the existing lucid dream induction techniques, including cognitive techniques, external stimulation, substance intervention, and cortical stimulation. The third aim was to assess the methodological quality of the studies included in the review. It was hypothesised that, comparing with the studies included in the last review, the studies included in the present review had better overall methodological quality. A total of 19 peer-reviewed studies were included and analysed in the present review, from which 14 lucid dream induction techniques were identified. The results indicated that the mnemonic induction of lucid dream technique was the most effective for inducing lucid dreams. Moreover, two new techniques, the senses-initiated lucid dream technique and galantamine intervention, might also be competitive candidates for lucid dream induction but further replications are needed. As hypothesised, the overall methodological quality of the studies included in the present review was higher than that of the studies included the previous review. In all, 17 studies had moderate methodological quality, whereas only three studies had poor methodological quality.
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Affiliation(s)
- Shuyue Tan
- School of Psychology Shenzhen University Shenzhen China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health Shenzhen China
| | - Jialin Fan
- School of Psychology Shenzhen University Shenzhen China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health Shenzhen China
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9
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Predictive coding, multisensory integration, and attentional control: A multicomponent framework for lucid dreaming. Proc Natl Acad Sci U S A 2022; 119:e2123418119. [PMID: 36279459 PMCID: PMC9636904 DOI: 10.1073/pnas.2123418119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Lucid dreaming (LD) is a mental state in which we realize not being awake but are dreaming while asleep. It often involves vivid, perceptually intense dream images as well as peculiar kinesthetic sensations, such as flying, levitating, or out-of-body experiences. LD is in the cross-spotlight of cognitive neuroscience and sleep research as a particular case to study consciousness, cognition, and the neural background of dream experiences. Here, we present a multicomponent framework for the study and understanding of neurocognitive mechanisms and phenomenological aspects of LD. We propose that LD is associated with prediction error signals arising during sleep and occurring at higher or lower levels of the processing hierarchy. Prediction errors are resolved by generating a superordinate self-model able to integrate ambiguous stimuli arriving from sensory periphery and higher-order cortical regions. While multisensory integration enables lucidity maintenance and contributes to peculiar kinesthetic experiences, attentional control facilitates multisensory integration by dynamically regulating the balance between the influence of top-down mental models and the precision weighting of bottom-up sensory inputs. Our novel framework aims to link neural correlates of LD with current concepts of sleep and arousal regulation and provide testable predictions on interindividual differences in LD as well as neurocognitive mechanisms inducing lucid dreams.
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10
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Tzioridou S, Dresler M, Sandberg K, Mueller EM. The role of mindful acceptance and lucid dreaming in nightmare frequency and distress. Sci Rep 2022; 12:15737. [PMID: 36131106 PMCID: PMC9492730 DOI: 10.1038/s41598-022-19624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Sofia Tzioridou
- Department of Psychology, Philipps University Marburg, Marburg, Germany. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kristian Sandberg
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Erik M Mueller
- Department of Psychology, Philipps University Marburg, Marburg, Germany
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11
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Scarpelli S, Alfonsi V, Gorgoni M, De Gennaro L. What about dreams? State of the art and open questions. J Sleep Res 2022; 31:e13609. [PMID: 35417930 PMCID: PMC9539486 DOI: 10.1111/jsr.13609] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023]
Abstract
Several studies have tried to identify the neurobiological bases of dream experiences, nevertheless some questions are still at the centre of the debate. Here, we summarise the main open issues concerning the neuroscientific study of dreaming. After overcoming the rapid eye movement (REM) ‐ non‐REM (NREM) sleep dichotomy, investigations have focussed on the specific functional or structural brain features predicting dream experience. On the one hand, some results underlined that specific trait‐like factors are associated with higher dream recall frequency. On the other hand, the electrophysiological milieu preceding dream report upon awakening is a crucial state‐like factor influencing the subsequent recall. Furthermore, dreaming is strictly related to waking experiences. Based on the continuity hypothesis, some findings reveal that dreaming could be modulated through visual, olfactory, or somatosensory stimulations. Also, it should be considered that the indirect access to dreaming remains an intrinsic limitation. Recent findings have revealed a greater concordance between parasomnia‐like events and dream contents. This means that parasomnia episodes might be an expression of the ongoing mental sleep activity and could represent a viable direct access to dream experience. Finally, we provide a picture on nightmares and emphasise the possible role of oneiric activity in psychotherapy. Overall, further efforts in dream science are needed (a) to develop a uniform protocol to study dream experience, (b) to introduce and integrate advanced techniques to better understand whether dreaming can be manipulated, (c) to clarify the relationship between parasomnia events and dreaming, and (d) to determine the clinical valence of dreams.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
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12
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Konjedi S, Maleeh R. The dynamic framework of mind wandering revisited: How mindful meta-awareness affects mental states' constraints. Conscious Cogn 2021; 95:103194. [PMID: 34419729 DOI: 10.1016/j.concog.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 01/01/2023]
Abstract
The dynamic framework of mind wandering (Christoff, Irving, Fox, Spreng, & Andrews-Hanna, 2016) is reviewed and modified through integrating the construct of mindful meta-awareness. The dynamic framework maintains that mind wandering belongs to a family of spontaneous thought phenomena. The key defining feature of mind wandering is 'spontaneity' which characterizes the dynamic nature of thoughts in the framework. The argument is made that incorporating the mindful meta-awareness construct modifies the dynamic framework as follows: (1) the framework's criteria for mind wandering do not hold anymore as meta-awareness changes the relationship between thoughts and constraints, and (2) lucid dreaming can be categorized as unguided thought while at the same time being dependent on deliberate constraints. Finally, the application of this modified framework will be discussed in terms of the treatment of mental disorders related to spontaneous thought alterations, in particular depression and nightmares.
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Affiliation(s)
| | - Reza Maleeh
- Institute of Cognitive Science, University of Osnabrück, 49069 Osnabrück, Germany; School of Historical and Philosophical Inquiry, The University of Queensland, Brisbane, St Lucia, QLD 4072, Australia.
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Abstract
Objectives/Background: Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being considered the first-line treatment for insomnia, it is not without its challenges. As such it is worthwhile to consider, and test, alternative or adjuvant management options. Methods/Participants: The aim of the present study was to examine whether Lucid Dreaming Training for insomnia (LDT-I) impacted on insomnia, depressive and anxious symptomology in an open label trial of 48 adults with Insomnia Disorder. Participants completed the Insomnia Severity Index, General Anxiety Disorder-7 and Patient Health Questionnaire at baseline then one month following LDT-I. Training consisted of four modules delivered over a period of two consecutive weeks. Results: The results suggest, albeit preliminarily, that LDT-I may have a place within the non-pharmacological management of insomnia, as there were significant reductions in insomnia severity (t(46) = 8.16,p <.001), anxious symptomology (t(46) = 4.75,p <.001) and depressive symptomology (t(46) = 5.87,p <.001). Further, the effect size in terms of pre-post reductions on ISI scores was large (dz 1.17). Conclusions: Whilst the results are promising, further testing of LDT-I is needed to inform its place amongst the non-pharmacological treatments for insomnia.
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Affiliation(s)
- Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University , Newcastle, UK
| | - Joseph De Koninck
- School of Psychology, University of Ottawa , Ottowa, Ontario, Canada
| | - Celyne H Bastien
- Department of Psychology, Université Laval , Quebec, Canada.,CERVO Research Center , Quebec, Canada
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14
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Krishnan D. Orchestration of dreams: a possible tool for enhancement of mental productivity and efficiency. Sleep Biol Rhythms 2021; 19:207-213. [PMID: 33526967 PMCID: PMC7839624 DOI: 10.1007/s41105-021-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
Deciphering the significance of dreams, remains a dream till date. A little is known about its underlying mechanism, brain regions involved and implications with wake life. This review is aimed to investigate the latest developments to summarize the differences in nature of dreams in Rapid eye movement and Non rapid eye movement sleep, possible role of dreams in day to day life with larger focus on Lucid Dreaming- its significant role in elevating productivity and efficiency. To carry out this review, combination of keywords like Lucid Dreaming, Rapid eye movement, Non rapid eye movement, Sleep Cycle, Dream Patterns, molecular mechanism of dreaming etc. were entered in databases like National library of Medicine, Google Scholar etc. Nature and composition of dreams are distinct in different sleep phases and it tends to influence cognitive skills, memory consolidation, mood and personal temperaments. It was observed that dreams in distinct phases, can be directly/indirectly related to development of cognition, skill enhancements, learning, healing, and even stress management affecting overall performance and productivity of an individual. Understanding the nature of dream contents in different phases can possibly inculcate insights for not only recovery aid in several mental illnesses but for elevated efficiency and productivity in normal individuals as well. Realising dreams as an effective tool for its contribution in daily activities might help organising our mood and overall mental well-being, a foremost component to thrive in the contemporary world which is currently undergoing the chaos of Novel Coronavirus Disease 2019.
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Affiliation(s)
- Dolly Krishnan
- Westfälische Wilhelms-Universität Münster, Münster, Germany
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15
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Holzinger B, Saletu B, Klösch G. Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder. Front Psychol 2020; 11:1826. [PMID: 32973600 PMCID: PMC7471655 DOI: 10.3389/fpsyg.2020.01826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria.,Certificate Programme Sleep Coaching, Medical University of Vienna, Vienna, Austria
| | - Bernd Saletu
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gerhard Klösch
- Institute for Consciousness and Dream Research, Vienna, Austria.,Department of Neurology, Medical University of Vienna, Vienna, Austria
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16
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Holzinger B, Mayer L. Lucid Dreaming Brain Network Based on Tholey's 7 Klartraum Criteria. Front Psychol 2020; 11:1885. [PMID: 32849106 PMCID: PMC7403396 DOI: 10.3389/fpsyg.2020.01885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Lucid dreaming refers to a dream state characterized by the dreamers’ awareness of being in a dream and being able to volitionally control its content. The aim of this study was to describe and model neurophysiological evidence for the seven awareness criteria of lucid dreaming based on those proposed by Paul Tholey. Each of the awareness criteria was analyzed separately with regard to its underlying neurocircuits. We hypothesized that not one, but several regions are involved in the state of lucid dreaming. Our results have shown a satisfactory overlap of the awareness criteria and the brain regions activated. During lucid dreaming, a brain network seems to emerge, that is something other than the sum of its parts. Further research is needed to understand the psychoneurological underpinnings of lucid dreams.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria.,Certificate Program Sleep Coaching, Medical University of Vienna, Vienna, Austria
| | - Lucille Mayer
- Institute for Consciousness and Dream Research, Vienna, Austria
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17
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Adventure-Heart DJ. Findings From the International Lucid Dream Induction Study. Front Psychol 2020; 11:1746. [PMID: 32765385 PMCID: PMC7379166 DOI: 10.3389/fpsyg.2020.01746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/24/2020] [Indexed: 12/03/2022] Open
Abstract
The International Lucid Dream Induction Study (ILDIS) investigated and compared the effectiveness of five different combinations of lucid dream induction techniques including reality testing (RT), Wake Back to Bed (WBTB), the Mnemonic Induction of Lucid Dreams (MILD) technique, the Senses Initiated Lucid Dream (SSILD) technique, and a hybrid technique combining elements of both MILD and SSILD. Participants with an interest in lucid dreaming (N = 355) completed a pre-test questionnaire and then a baseline sleep and dream recall logbook for 1 week before practicing the lucid dream induction techniques for another week. Results indicated that the MILD technique and the SSILD technique were similarly effective for inducing lucid dreams. The hybrid technique showed no advantage over MILD or SSILD. Predictors of successful lucid dream induction included superior general dream recall and the ability to fall asleep within 10 min of completing the lucid dream induction techniques. Successful lucid dream induction had no adverse effect on sleep quality. Findings indicated that the techniques were effective regardless of baseline lucid dreaming frequency or prior experience with lucid dreaming techniques. Recommendations for further research on lucid dream induction techniques are provided.
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18
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Dream lucidity is associated with positive waking mood. Conscious Cogn 2020; 83:102971. [PMID: 32535498 DOI: 10.1016/j.concog.2020.102971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/22/2022]
Abstract
Lucid dreaming is a unique phenomenon with potential applications for therapeutic interventions. Few studies have investigated the effects of lucidity on an individual's waking mood, which could have valuable implications for improving psychological wellbeing. The current experiment aims to investigate whether the experience of lucidity enhances positive waking mood, and whether lucidity is associated with dream emotional content and subjective sleep quality. 20 participants were asked to complete lucid dream induction techniques along with an online dream diary for one week, which featured a 19-item lucidity questionnaire, and subjective ratings of sleep quality, dream emotional content, and waking mood. Results indicated that higher lucidity was associated with more positive dream content and elevated positive waking mood the next day, although there was no relationship with sleep quality. The results of the research and suggestions for future investigations, such as the need for longitudinal studies of lucidity and mood, are discussed.
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19
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Inducing signal-verified lucid dreams in 40% of untrained novice lucid dreamers within two nights in a sleep laboratory setting. Conscious Cogn 2020; 83:102960. [PMID: 32526491 DOI: 10.1016/j.concog.2020.102960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
Dreams in which the dreamer is aware of the dream state (lucid dreams, LD) are difficult to induce in naïve subjects in-laboratory. Recently, Stumbrys and Erlacher (2014) used a combination of existing induction techniques together with a self-developed experiment protocol and achieved comparatively high LD induction rates. In this study, we simplified their methodology slightly and repeated their experiment with twenty naïve subjects who spent one or two nights in our sleep laboratory. After about six hours of sleep, they were woken up during REM sleep and engaged in a series of cognitive tasks before going back to bed. Ten subjects reported a LD during the following period of sleep in one of the nights. Eight of these subjects gave a predefined eye signal, which was clearly visible in the electrooculogram during REM sleep. In summary, we replicated Stumbrys and Erlacher's results using a simplified version of their induction protocol.
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20
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van Heugten-van der Kloet D, Lynn SJ. Dreams and Dissociation-Commonalities as a Basis for Future Research and Clinical Innovations. Front Psychol 2020; 11:745. [PMID: 32390913 PMCID: PMC7189023 DOI: 10.3389/fpsyg.2020.00745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dalena van Heugten-van der Kloet
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Steven Jay Lynn
- Psychology Department, Binghamton University (SUNY), Binghamton, NY, United States
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21
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Soffer-Dudek N. Are Lucid Dreams Good for Us? Are We Asking the Right Question? A Call for Caution in Lucid Dream Research. Front Neurosci 2020; 13:1423. [PMID: 32038133 PMCID: PMC6993576 DOI: 10.3389/fnins.2019.01423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Nirit Soffer-Dudek
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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22
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Ntafouli M, Galbiati A, Gazea M, Bassetti CLA, Bargiotas P. Update on nonpharmacological interventions in parasomnias. Postgrad Med 2019; 132:72-79. [PMID: 31760836 DOI: 10.1080/00325481.2019.1697119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parasomnias are abnormal behaviors that occur during sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction, and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Longterm pharmacological treatments are not always well tolerated and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various nonpharmacological techniques on different types of parasomnias and provide a glimpse into the future of nonpharmacological treatments in this field.
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Affiliation(s)
- Maria Ntafouli
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mary Gazea
- Centre for experimental Neurology, Dept. of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Biomedical Research (DBMR), Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Panagiotis Bargiotas
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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23
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de Macêdo TCF, Ferreira GH, de Almondes KM, Kirov R, Mota-Rolim SA. My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? Front Psychol 2019; 10:2618. [PMID: 31849749 PMCID: PMC6902039 DOI: 10.3389/fpsyg.2019.02618] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Katie Moraes de Almondes
- Department of Psychology, Postgraduate Program in Psychobiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Roumen Kirov
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Sérgio Arthuro Mota-Rolim
- Brain Institute, Physiology and Behavior Department, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
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24
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Scarpelli S, Bartolacci C, D'Atri A, Gorgoni M, De Gennaro L. Mental Sleep Activity and Disturbing Dreams in the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3658. [PMID: 31569467 PMCID: PMC6801786 DOI: 10.3390/ijerph16193658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Sleep significantly changes across the lifespan, and several studies underline its crucial role in cognitive functioning. Similarly, mental activity during sleep tends to covary with age. This review aims to analyze the characteristics of dreaming and disturbing dreams at different age brackets. On the one hand, dreams may be considered an expression of brain maturation and cognitive development, showing relations with memory and visuo-spatial abilities. Some investigations reveal that specific electrophysiological patterns, such as frontal theta oscillations, underlie dreams during sleep, as well as episodic memories in the waking state, both in young and older adults. On the other hand, considering the role of dreaming in emotional processing and regulation, the available literature suggests that mental sleep activity could have a beneficial role when stressful events occur at different age ranges. We highlight that nightmares and bad dreams might represent an attempt to cope the adverse events, and the degrees of cognitive-brain maturation could impact on these mechanisms across the lifespan. Future investigations are necessary to clarify these relations. Clinical protocols could be designed to improve cognitive functioning and emotional regulation by modifying the dream contents or the ability to recall/non-recall them.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Chiara Bartolacci
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Aurora D'Atri
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Maurizio Gorgoni
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Luigi De Gennaro
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
- IRCCS Santa Lucia Foundation, 00142 Rome, Italy.
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25
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Baird B, Mota-Rolim SA, Dresler M. The cognitive neuroscience of lucid dreaming. Neurosci Biobehav Rev 2019; 100:305-323. [PMID: 30880167 PMCID: PMC6451677 DOI: 10.1016/j.neubiorev.2019.03.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022]
Abstract
Lucid dreaming refers to the phenomenon of becoming aware of the fact that one is dreaming during ongoing sleep. Despite having been physiologically validated for decades, the neurobiology of lucid dreaming is still incompletely characterized. Here we review the neuroscientific literature on lucid dreaming, including electroencephalographic, neuroimaging, brain lesion, pharmacological and brain stimulation studies. Electroencephalographic studies of lucid dreaming are mostly underpowered and show mixed results. Neuroimaging data is scant but preliminary results suggest that prefrontal and parietal regions are involved in lucid dreaming. A focus of research is also to develop methods to induce lucid dreams. Combining training in mental set with cholinergic stimulation has shown promising results, while it remains unclear whether electrical brain stimulation could be used to induce lucid dreams. Finally, we discuss strategies to measure lucid dreaming, including best-practice procedures for the sleep laboratory. Lucid dreaming has clinical and scientific applications, and shows emerging potential as a methodology in the cognitive neuroscience of consciousness. Further research with larger sample sizes and refined methodology is needed.
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Affiliation(s)
- Benjamin Baird
- Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA.
| | - Sergio A Mota-Rolim
- Brain Institute, Physiology Department and Onofre Lopes University Hospital - Federal University of Rio Grande do Norte, Natal, Brazil
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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26
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Scarpelli S, Bartolacci C, D'Atri A, Gorgoni M, De Gennaro L. The Functional Role of Dreaming in Emotional Processes. Front Psychol 2019; 10:459. [PMID: 30930809 PMCID: PMC6428732 DOI: 10.3389/fpsyg.2019.00459] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 02/05/2023] Open
Abstract
Dream experience (DE) represents a fascinating condition linked to emotional processes and the human inner world. Although the overlap between REM sleep and dreaming has been overcome, several studies point out that emotional and perceptually vivid contents are more frequent when reported upon awakenings from this sleep stage. Actually, it is well-known that REM sleep plays a pivotal role in the processing of salient and emotional waking-life experiences, strongly contributing to the emotional memory consolidation. In this vein, we highlighted that, to some extent, neuroimaging studies showed that the processes that regulate dreaming and emotional salience in sleep mentation share similar neural substrates of those controlling emotions during wakefulness. Furthermore, the research on EEG correlates of the presence/absence of DE and the results on EEG pattern related to the incorporated memories converged to assign a crucial role of REM theta oscillations in emotional re-processing. In particular, the theta activity is involved in memory processes during REM sleep as well as during the waking state, in line with the continuity hypothesis. Also, the gamma activity seems to be related to emotional processes and dream recall as well as to lucid dreams. Interestingly, similar EEG correlates of DE have been found in clinical samples when nightmares or dreams occur. Research on clinical samples revealed that promoting the rehearsal of frightening contents aimed to change them is a promising method to treat nightmares, and that lucid dreams are associated with an attenuation of nightmares. In this view, DE can defuse emotional traumatic memories when the emotional regulation and the fear extinction mechanisms are compromised by traumatic and frightening events. Finally, dreams could represent a sort of simulation of reality, providing the possibility to create a new scenario with emotional mastery elements to cope with dysphoric items included in nightmares. In addition, it could be hypothesized that the insertion of bizarre items besides traumatic memories might be functional to "impoverish" the negative charge of the experiences.
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Affiliation(s)
| | | | | | | | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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27
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Gieselmann A, Ait Aoudia M, Carr M, Germain A, Gorzka R, Holzinger B, Kleim B, Krakow B, Kunze AE, Lancee J, Nadorff MR, Nielsen T, Riemann D, Sandahl H, Schlarb AA, Schmid C, Schredl M, Spoormaker VI, Steil R, van Schagen AM, Wittmann L, Zschoche M, Pietrowsky R. Aetiology and treatment of nightmare disorder: State of the art and future perspectives. J Sleep Res 2019; 28:e12820. [PMID: 30697860 PMCID: PMC6850667 DOI: 10.1111/jsr.12820] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non‐traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep‐disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence‐based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.
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Affiliation(s)
- Annika Gieselmann
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malik Ait Aoudia
- Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France
| | - Michelle Carr
- Department of Psychology, Swansea University, Swansea, UK
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Gorzka
- Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | | | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland
| | - Barry Krakow
- Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA
| | - Anna E Kunze
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Angelika A Schlarb
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Carolin Schmid
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Annette M van Schagen
- Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands
| | - Lutz Wittmann
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Maria Zschoche
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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28
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Schiappa C, Scarpelli S, D’Atri A, Gorgoni M, De Gennaro L. Narcolepsy and emotional experience: a review of the literature. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2018; 14:19. [PMID: 30587203 PMCID: PMC6305999 DOI: 10.1186/s12993-018-0151-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Abstract
Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. This disease affects significantly the overall patient functioning, interfering with social, work, and affective life. Some symptoms of narcolepsy depend on emotional stimuli; for instance, cataplectic attacks can be triggered by emotional inputs such as laughing, joking, a pleasant surprise, and also anger. Neurophysiological and neurochemical findings suggest the involvement of emotional brain circuits in the physiopathology of cataplexy, which seems to depending on the dysfunctional interplay between the hypothalamus and the amygdala associated with an alteration of hypocretin levels. Furthermore, behavioral studies suggest an impairment of emotions processing in narcolepsy-cataplexy (NC), like a probable coping strategy to avoid or reduce the frequency of cataplexy attacks. Consistently, NC patients seem to use coping strategies even during their sleep, avoiding unpleasant mental sleep activity through lucid dreaming. Interestingly, NC patients, even during sleep, have a different emotional experience than healthy subjects, with more vivid, bizarre, and frightening dreams. Notwithstanding this evidence, the relationship between emotion and narcolepsy is poorly investigated. This review aims to provide a synthesis of behavioral, neurophysiological, and neurochemical evidence to discuss the complex relationship between NC and emotional experience and to direct future research.
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Affiliation(s)
- C. Schiappa
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - S. Scarpelli
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - A. D’Atri
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - M. Gorgoni
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
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29
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Voss U, D'Agostino A, Kolibius L, Klimke A, Scarone S, Hobson JA. Insight and Dissociation in Lucid Dreaming and Psychosis. Front Psychol 2018; 9:2164. [PMID: 30483185 PMCID: PMC6241172 DOI: 10.3389/fpsyg.2018.02164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
Dreams and psychosis share several important features regarding symptoms and underlying neurobiology, which is helpful in constructing a testable model of, for example, schizophrenia and delirium. The purpose of the present communication is to discuss two major concepts in dreaming and psychosis that have received much attention in the recent literature: insight and dissociation. Both phenomena are considered functions of higher order consciousness because they involve metacognition in the form of reflective thought and attempted control of negative emotional impact. Insight in dreams is a core criterion for lucid dreams. Lucid dreams are usually accompanied by attempts to control the dream plot and dissociative elements akin to depersonalization and derealization. These concepts are also relevant in psychotic illness. Whereas insightfulness can be considered innocuous in lucid dreaming and even advantageous in psychosis, the concept of dissociation is still unresolved. The present review compares correlates and functions of insight and dissociation in lucid dreaming and psychosis. This is helpful in understanding the two concepts with regard to psychological function as well as neurophysiology.
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Affiliation(s)
- Ursula Voss
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,VITOS Hochtaunus Klinik, Psychiatrisches Krankenhaus, Friedrichsdorf, Germany
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Luca Kolibius
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,VITOS Hochtaunus Klinik, Psychiatrisches Krankenhaus, Friedrichsdorf, Germany
| | - Ansgar Klimke
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,Department of Psychiatry, Psychiatry Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Silvio Scarone
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - J Allan Hobson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Sleep and mindfulness meditation as they relate to false memory. PSYCHOLOGICAL RESEARCH 2018; 84:1084-1111. [PMID: 30244286 DOI: 10.1007/s00426-018-1098-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/17/2018] [Indexed: 12/24/2022]
Abstract
By a systematic analysis of the current literature, we compare two states of sleep and meditation in terms of their role in the formation or suppression of Deese-Roediger-McDermott (DRM) false memory. We aim to suggest that the occurrence of false memory under these two states is a result of reinforcing some abilities and changes in cognitive systems which can ultimately improve some aspects of cognitive functions. In our analogy, we propose that: (1) both sleep and meditation may improve source monitoring ability whose failure is one of the most important mechanisms in producing false memories, and (2) despite improvement in source monitoring ability, adaptive cognitive processes, as mechanisms which are common in sleep and meditation, can still produce false memories. In conclusion, we propose that in spite of their contribution to false memory through adaptive processes, the beneficial role of sleep and meditation in cognition may be more prominent than their harmful role.
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Sparrow G, Hurd R, Carlson R, Molina A. Exploring the effects of galantamine paired with meditation and dream reliving on recalled dreams: Toward an integrated protocol for lucid dream induction and nightmare resolution. Conscious Cogn 2018; 63:74-88. [PMID: 29960246 DOI: 10.1016/j.concog.2018.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
An experimental home study examined the impact of a pre-sleep protocol for enhancing self-awareness, lucidity, and responsiveness in dreams. It included ingesting the cholinesterase inhibitor galantamine--which is widely reported to increase the frequency of lucid dreaming--prior to engaging in middle-of-the-night meditation and the imaginary reliving of a distressing dream while exercising new responses. Thirty-five participants completed an eight-night study, which included pre- and post-baseline nights and six conditions: waking for 40 min before returning to bed, called Wake-Back-to-Bed (WBTB); Wake-Back-to-Bed plus placebo (WBTB + P); Wake-Back-to-Bed plus galantamine (WBTB + G); meditation and dream reliving (MDR); meditation and dream reliving plus placebo (MDR + P); and meditation and dream reliving plus galantamine (MDR + G). The outcome measures included lucidity, reflectiveness, interactive behavior, role change, constructive action, and fear and threat, as measured by the participants' self-ratings. The results support the use of this protocol in further studies of lucid dream induction and nightmare/trauma resolution.
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Affiliation(s)
- Gregory Sparrow
- Dept. of Counseling, University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, United States.
| | - Ryan Hurd
- Dept. of Psychology, John F. Kennedy University, Orinda, CA, United States
| | - Ralph Carlson
- Dept. of Educational Psychology, 1201 W. University Dr., University of Texas Rio Grande Valley, Edinburg, TX 78539, United States
| | - Ana Molina
- Dept. of Educational Psychology, 1201 W. University Dr., University of Texas Rio Grande Valley, Edinburg, TX 78539, United States
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Morgenthaler TI, Auerbach S, Casey KR, Kristo D, Maganti R, Ramar K, Zak R, Kartje R. Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. J Clin Sleep Med 2018; 14:1041-1055. [PMID: 29852917 DOI: 10.5664/jcsm.7178] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Nightmare disorder affects approximately 4% of adults, occurring in isolation or as part of other disorders such as posttraumatic stress disorder (PTSD), and can significantly impair quality of life. This paper provides the American Academy of Sleep Medicine (AASM) position regarding various treatments of nightmare disorder in adults. METHODS A literature search was performed based upon the keywords and MeSH terms from the Best Practice Guide for the Treatment of Nightmare Disorder in Adults that was published in 2010 by the AASM. The search used the date range March 2009 to August of 2017, and sought to find available evidence pertaining to the use of behavioral, psychological, and pharmacologic therapies for the treatment of nightmares. A task force developed position statements based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statements. DETERMINATION OF POSITION Positions of "recommended" and "not recommended" indicate that a treatment option is determined to be clearly useful or ineffective/harmful for most patients, respectively, based on a qualitative assessment of the available evidence and clinical judgement of the task force. Positions of "may be used" indicate that the evidence or expert consensus is less clear, either in favor or against the use of a treatment option. The interventions listed below are in alphabetical order within the position statements rather than clinical preference: this is not meant to be instructive of the order in which interventions should be used. POSITION STATEMENTS The following therapy is recommended for the treatment of PTSD-associated nightmares and nightmare disorder: image rehearsal therapy. The following therapies may be used for the treatment of PTSD-associated nightmares: cognitive behavioral therapy; cognitive behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. The following therapies may be used for the treatment of nightmare disorder: cognitive behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam. The following are not recommended for the treatment of nightmare disorder: clonazepam and venlafaxine. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, accessible treatment options, and resources.
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Affiliation(s)
| | | | - Kenneth R Casey
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - David Kristo
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Rochelle Zak
- University of California, San Francisco, California
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Rachakonda TD, Balba NM, Lim MM. Trauma-Associated Sleep Disturbances: a Distinct Sleep Disorder? CURRENT SLEEP MEDICINE REPORTS 2018; 4:143-148. [PMID: 30656131 PMCID: PMC6330699 DOI: 10.1007/s40675-018-0119-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW This paper describes a newly proposed sleep disorder, trauma-associated sleep disorder (TSD). Whether or not this represents a truly unique condition is controversial. In this paper, we describe the overlapping features and differences between TSD, post-traumatic stress disorder (PTSD) and Rapid Eye Movement (REM) sleep behavior disorder (RBD). RECENT FINDINGS While REM sleep without atonia (RWA) and dream enactment are part of the diagnostic criteria for both RBD and TSD, only TSD features nightmares that occur both in non-REM and REM. A key difference between TSD and PTSD is the presence of symptoms during wakefulness in the latter, though the relationship between the two disorders is, as of yet, unclear. It is unknown whether or not a relationship exists between TSD and neurodegeneration, thus this needs to be explored further. SUMMARY Additional research, such as application of TSD diagnostic criteria to more diverse population, would help to determine whether or not TSD is a distinct clinical entity, its relationships to PTSD, as well as the association of this condition with the development of neurodegeneration.
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Affiliation(s)
| | - Nadir M. Balba
- VA Portland Health Care System
- Oregon Health & Science University
| | - Miranda M. Lim
- VA Portland Health Care System
- Oregon Health & Science University
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Aviram L, Soffer-Dudek N. Lucid Dreaming: Intensity, But Not Frequency, Is Inversely Related to Psychopathology. Front Psychol 2018; 9:384. [PMID: 29623062 PMCID: PMC5875414 DOI: 10.3389/fpsyg.2018.00384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/08/2018] [Indexed: 11/17/2022] Open
Abstract
Lucid dreaming (LD) is awareness that one is dreaming, during the dream state. However, some define and assess LD relying also on controlling dream events, although control is present only in a subset of lucid dreams. LD has been claimed to represent well-being, and has even been used as a therapeutic agent. Conversely, LD is associated with mixed sleep-wake states, which are related to bizarre cognitions, stress, and psychopathology, and have been construed as arousal permeating and disrupting sleep. We propose that previous conflicting findings regarding relations between LD and both psychopathology and well-being, stem from the non-differentiated assessment of frequency and control. The present study aimed to develop an expansive measure of several LD characteristics (the Frequency and Intensity Lucid Dream questionnaire; FILD), and explore their relations with symptomatology. Undergraduate students (N = 187) self-reported trait LD, psychopathology (depression, anxiety, obsessive-compulsive symptoms, dissociation, and schizotypy), stress, and sleep problems; 2 months later, a subsample (n = 78) reported psychopathology again, and also completed a dream diary each morning for 14 days. Preliminary evidence supports the reliability and validity of the FILD. Items converged into four domains: frequency, intensity (e.g., control, activity, certainty of dreaming), emotional valence, and the use of induction techniques. We report an optimal frequency cutoff score to identify those likely to experience LD within a 2-week period. Whereas LD frequency was unrelated to psychopathology, LD intensity, and positive LD emotions, were inversely associated with several psychopathological symptoms. Use of deliberate induction techniques was positively associated with psychopathology and sleep problems. Additionally, we demonstrated directionality by employing a prospective-longitudinal design, showing that deliberate LD induction predicted an increase in dissociation and schizotypy symptoms across 2 months. We conclude that lucidity should not be considered as necessarily suggestive of well-being; LD may be positive or negative, depending on lucidity characteristics. Additionally, deliberate LD induction may harbor negative long-term risk.
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Affiliation(s)
| | - Nirit Soffer-Dudek
- The Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Schredl M, Göritz AS. Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares. J Clin Sleep Med 2018; 14:465-471. [PMID: 29458691 DOI: 10.5664/jcsm.7002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Even though the common diagnostic criteria (ICSD-3, DSM-5) acknowledge that nightmares do not only contain anxiety/fear (definition of the ICD-10) but also other emotions such as grief, disgust, and anger, the definition of a nightmare still focuses on threats to survival, security, or physical integrity. However, empirical studies on nightmare content in larger samples are scarce. METHODS The current study elicited 1,216 of the most recent nightmares including childhood nightmares of a population-based sample. RESULTS The findings show that nightmares encompass a diversity of different topics, being chased, physical aggression, including death/injury of close persons. Infrequent themes like being the aggressor and suicide are of special interest as they might be related to waking-life psychopathology. CONCLUSIONS The variety of nightmare topics clearly indicate that current definitions of nightmare content are too narrow. Future studies should look into nightmare content of persons in whom nightmare disorder has been diagnosed.
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Affiliation(s)
- Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Anja S Göritz
- Psychology Department, University of Freiburg, Freiburg, Germany
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Abstract
Sleep paralysis is the unusual experience of waking up in the night without the ability to move. Currently little is known about the experience, despite the fact that the vast majority of episodes are associated with extreme fear and in a minority of cases can lead to clinically significant levels of distress. The aim of this work was to review the existing literature pertaining to the relationship sleep paralysis has to sleep more generally, measured both with subjective questionnaires and objective laboratory recordings. In terms of subjective sleep variables, worse sleep quality has been found in multiple studies to be associated with increased odds of sleep paralysis occurrence. In addition, insomnia symptoms (but not a diagnosed insomnia disorder) have also been found to predict sleep paralysis. Associations between sleep paralysis and other unusual and/or threatening sleep experiences such as nightmares, exploding head syndrome, and lucid dreaming have been reported. In terms of objective measurements, the limited literature to date shows sleep paralysis to be a "mixed" state of consciousness, combining elements of rapid eye movement sleep with elements of wakefulness. Future research needs to focus on longitudinal designs to disentangle the direction of effects and more typically employ a broader assessment of sleep paralysis that better captures associated features such as hallucinations, fear, and distress.
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Affiliation(s)
- Dan Denis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA, .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,
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A novel Differential Susceptibility framework for the study of nightmares: Evidence for trait sensory processing sensitivity. Clin Psychol Rev 2017; 58:86-96. [DOI: 10.1016/j.cpr.2017.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/02/2017] [Accepted: 10/15/2017] [Indexed: 12/21/2022]
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Mutz J, Javadi AH. Exploring the neural correlates of dream phenomenology and altered states of consciousness during sleep. Neurosci Conscious 2017; 2017:nix009. [PMID: 30042842 PMCID: PMC6007136 DOI: 10.1093/nc/nix009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 03/29/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
The science of dreaming constitutes a relevant topic in modern-day neuroscientific research and provides major insights into the study of human consciousness. Linking specific, universal, and regularly occurring stages of sleep with dreaming encourages the direct and systematic investigation of a topic that has fascinated humankind for centuries. In this review, we explore to what extent individuals dream during periods of rapid eye movement and non-rapid eye movement sleep, and we introduce research on lucid dreaming. We then discuss how dreaming during different stages of sleep varies in terms of phenomenological characteristics, and to what extent individuals are conscious throughout the sleep cycle. Finally, we provide a synopsis of the previous literature on brain activity during sleep, and we aim to clarify how the neurofunctional changes observed throughout sleep may lead to changes in phenomenological aspects of dreams, and in the domain of consciousness.
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Affiliation(s)
- Julian Mutz
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
| | - Amir-Homayoun Javadi
- School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK
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Llewellyn S. Crossing the invisible line: De-differentiation of wake, sleep and dreaming may engender both creative insight and psychopathology. Conscious Cogn 2016; 46:127-147. [DOI: 10.1016/j.concog.2016.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/13/2016] [Indexed: 12/21/2022]
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Lucid dreaming incidence: A quality effects meta-analysis of 50 years of research. Conscious Cogn 2016; 43:197-215. [DOI: 10.1016/j.concog.2016.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/17/2016] [Accepted: 06/03/2016] [Indexed: 11/22/2022]
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Rotenberg VS. Lucid dreams: their advantage and disadvantage in the frame of search activity concept. Front Psychol 2015; 6:1472. [PMID: 26483727 PMCID: PMC4588635 DOI: 10.3389/fpsyg.2015.01472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/14/2015] [Indexed: 12/03/2022] Open
Abstract
Search activity (SA) is the behavioral and mental activity that is oriented to changes of the environment or of the subject's view and approach to the environment according to personal needs without the definite probability forecast of the outcomes of such activity, but with a regular consideration of the outcomes in the process of active behavior. Dream's lucidity (the subject's realization that he/she is dreaming) protects dreamer from awakenings during emotionally disturbing or frustrating dreams, because lucid dreams allow subject to feel separated from the dream events that may cause a feeling of helplessness. Due to such a protection from awakenings that can bring subject back to the frustration in wakefulness, subject can turn in the further sleep to normal non-lucid dreams that are restoring subject's SA in the subsequent wakefulness (activity in the uncertain situation with the feedback between behavior and its outcome). It is the advantage of lucid dreams. Their disadvantage is that due to the separation from the dream events that are in lucid dreams accepted as rationalized dreams, not as real stories where the dreamer acts like in wakefulness, their ability to restore SA is decreased until they are not displaced by the normal non-lucid dreams accepted as real stories.
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Affiliation(s)
- Vadim S Rotenberg
- Formerly affiliated with Abarbanel Mental Health Center, Tel-Aviv University Bat-Yam, Israel
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Holzinger B, Klösch G, Saletu B. Studies with lucid dreaming as add-on therapy to Gestalt therapy. Acta Neurol Scand 2015; 131:355-63. [PMID: 25639732 DOI: 10.1111/ane.12362] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of the present exploratory clinical study was to evaluate LD as an add-on therapy for treating nightmares. METHODS Thirty-two subjects having nightmares (ICD-10: F51.5) at least twice a week participated. Subjects were randomly assigned to group: A) Gestalt therapy group (= GTG), or B) Gestalt and lucid dreaming group therapy (= LDG). Each group lasted ten weeks. Participants kept a sleep/dream diary over the treatment. Examinations with respect to nightmare frequency and sleep quality (Pittsburgh Sleep Quality Index) were carried out at the beginning, after five and ten weeks and at a follow-up three months later. RESULTS Concerning nightmare frequency, a significant reduction was found in both groups after the ten-week-study and at the follow-up (Wilcoxon test: P ≤ 0.05). Significant reduction in dream recall frequency could only be observed in the GTG (Wilcoxon test: P ≤ 0.05). For subjects having succeeded in learning lucid dreaming, reduction was sooner and higher. Sleep quality improved for both groups at the follow-up (P ≤ 0.05, Wilcoxon test). Only the LDG showed significant improvement at the end of therapy (P ≤ 0.05). CONCLUSION Lucid dreaming, in combination with Gestalt therapy, is a potent technique to reduce nightmare frequency and improve the subjective quality of sleep.
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Affiliation(s)
- B. Holzinger
- Institute for Consciousness and Dream Research; Vienna Austria
- Department of Psychology; Webster University; Vienna Austria
| | - G. Klösch
- Institute for Consciousness and Dream Research; Vienna Austria
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - B. Saletu
- Department of Psychiatry and Psychotherapy; Medical University of Vienna; Vienna Austria
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Behavioural and Cognitive-Behavioural Treatments of Parasomnias. Behav Neurol 2015; 2015:786928. [PMID: 26101458 PMCID: PMC4458546 DOI: 10.1155/2015/786928] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022] Open
Abstract
Parasomnias are unpleasant or undesirable behaviours or experiences that occur predominantly during or within close proximity to sleep. Pharmacological treatments of parasomnias are available, but their efficacy is established only for few disorders. Furthermore, most of these disorders tend spontaneously to remit with development. Nonpharmacological treatments therefore represent valid therapeutic choices. This paper reviews behavioural and cognitive-behavioural managements employed for parasomnias. Referring to the ICSD-3 nosology we consider, respectively, NREM parasomnias, REM parasomnias, and other parasomnias. Although the efficacy of some of these treatments is proved, in other cases their clinical evidence cannot be provided because of the small size of the samples. Due to the rarity of some parasomnias, further multicentric researches are needed in order to offer a more complete account of behavioural and cognitive-behavioural treatments efficacy.
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Rak M, Beitinger P, Steiger A, Schredl M, Dresler M. Increased lucid dreaming frequency in narcolepsy. Sleep 2015; 38:787-92. [PMID: 25325481 DOI: 10.5665/sleep.4676] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/26/2014] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVE Nightmares are a frequent symptom in narcolepsy. Lucid dreaming, i.e., the phenomenon of becoming aware of the dreaming state during dreaming, has been demonstrated to be of therapeutic value for recurrent nightmares. Data on lucid dreaming in narcolepsy patients, however, is sparse. The aim of this study was to evaluate the frequency of recalled dreams (DF), nightmares (NF), and lucid dreams (LDF) in narcolepsy patients compared to healthy controls. In addition, we explored if dream lucidity provides relief during nightmares in narcolepsy patients. DESIGN We interviewed patients with narcolepsy and healthy controls. SETTING Telephone interview. PATIENTS 60 patients diagnosed with narcolepsy (23-82 years, 35 females) and 919 control subjects (14-93 years, 497 females). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Logistic regression revealed significant (P < 0.001) differences in DF, NF, and LDF between narcolepsy patients and controls after controlling for age and gender, with effect sizes lying in the large range (Cohen's d > 0.8). The differences in NF and LDF between patients and controls stayed significant after controlling for DF. Comparison of 35 narcolepsy patients currently under medication with their former drug-free period revealed significant differences in DF and NF (z < 0.05, signed-rank test) but not LDF (z = 0.8). Irrespective of medication, 70% of narcolepsy patients with experience in lucid dreaming indicated that dream lucidity provides relief during nightmares. CONCLUSION Narcolepsy patients experience a markedly higher lucid dreaming frequency compared to controls, and many patients report a positive impact of dream lucidity on the distress experienced from nightmares.
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Affiliation(s)
- Michael Rak
- Max-Plank-Institute of Psychiatry, Munich, Germany
| | | | - Axel Steiger
- Max-Plank-Institute of Psychiatry, Munich, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Martin Dresler
- Max-Plank-Institute of Psychiatry, Munich, Germany.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Lake J. The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel. ADVANCES IN INTEGRATIVE MEDICINE 2015. [DOI: 10.1016/j.aimed.2014.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schredl M. Editorial for “Nightmares in narcolepsy – under-investigated symptom?” (SLEEP-D-13-00591) Understanding and treating nightmares in patients with narcolepsy. Sleep Med 2014; 15:851-2. [DOI: 10.1016/j.sleep.2014.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
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Dresler M, Wehrle R, Spoormaker VI, Steiger A, Holsboer F, Czisch M, Hobson JA. Neural correlates of insight in dreaming and psychosis. Sleep Med Rev 2014; 20:92-9. [PMID: 25092021 DOI: 10.1016/j.smrv.2014.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/06/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022]
Abstract
The idea that dreaming can serve as a model for psychosis has a long and honourable tradition, however it is notoriously speculative. Here we demonstrate that recent research on the phenomenon of lucid dreaming sheds new light on the debate. Lucid dreaming is a rare state of sleep in which the dreamer gains insight into his state of mind during dreaming. Recent electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) data for the first time allow very specific hypotheses about the dream-psychosis relationship: if dreaming is a reasonable model for psychosis, then insight into the dreaming state and insight into the psychotic state should share similar neural correlates. This indeed seems to be the case: cortical areas activated during lucid dreaming show striking overlap with brain regions that are impaired in psychotic patients who lack insight into their pathological state. This parallel allows for new therapeutic approaches and ways to test antipsychotic medication.
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Affiliation(s)
- Martin Dresler
- Max Planck Institute of Psychiatry, Munich, Germany; Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.
| | | | | | - Axel Steiger
- Max Planck Institute of Psychiatry, Munich, Germany
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Nadorff MR, Lambdin KK, Germain A. Pharmacological and non-pharmacological treatments for nightmare disorder. Int Rev Psychiatry 2014; 26:225-36. [PMID: 24892897 DOI: 10.3109/09540261.2014.888989] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interest in the treatment of nightmares has greatly increased over the last several years as research has demonstrated the clinical significance of nightmare disorder. This paper provides an overview of nightmare disorder, its clinical relevance, and the leading treatments that are available. In particular, the paper defines nightmare disorder and then summarize the recent literature examining the clinical relevance of nightmare disorder, including its relation to post-traumatic stress disorder and other psychiatric conditions. The relation between nightmares and suicidality is also discussed. Recent findings on the treatment of nightmare with imagery rehearsal therapy and prazosin are then summarized. Lastly, the paper comments on potential future uses of nightmare treatment including using imagery rehearsal therapy or prazosin as a first-line intervention for post-traumatic stress disorder and using these treatments as an adjunctive therapy to reduce suicide risk in those at risk of suicide with nightmares.
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Affiliation(s)
- Michael R Nadorff
- Department of Psychology, Mississippi State University , Starkville, Mississippi
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