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Tzioridou S, Campillo-Ferrer T, Cañas-Martín J, Schlüter L, Torres-Platas SG, Gott JA, Soffer-Dudek N, Stumbrys T, Dresler M. The clinical neuroscience of lucid dreaming. Neurosci Biobehav Rev 2025; 169:106011. [PMID: 39818345 DOI: 10.1016/j.neubiorev.2025.106011] [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: 08/08/2024] [Revised: 12/16/2024] [Accepted: 01/11/2025] [Indexed: 01/18/2025]
Abstract
During most dreams, the dreamer does not realize that they are in a dream. In contrast, lucid dreaming allows to become aware of the current state of mind, often accompanied by considerable control over the ongoing dream episode. Lucid dreams can happen spontaneously or be induced through diverse behavioural, cognitive or technological strategies. Such induction techniques have spurred research into the potential therapeutic aspects of lucid dreams. In this review, we gather evidence on the link between lucid dreams and conditions like nightmare disorder, depression, anxiety, psychosis, and dissociative states, and highlight the possible neurobiological basis of these associations. Furthermore, we explore contemplative sleep practices that train lucid states during sleep, such as Dream/Sleep Yoga and Yoga Nidrâ. The potential drawbacks of lucid dreaming interventions are outlined, accompanied by an examination of the impacts of lucid dreams on individuals without clinical conditions. By shedding light on these intricate relationships, the review contributes to a deeper understanding of the therapeutic possibilities and implications of lucid dreaming.
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Affiliation(s)
- Sofia Tzioridou
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Philipps University Marburg, Marburg, Germany
| | - Teresa Campillo-Ferrer
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Ruhr University Bochum, Bochum, Germany
| | - Jorge Cañas-Martín
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Linda Schlüter
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Susana G Torres-Platas
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Northwestern University, Chicago, USA
| | - Jarrod A Gott
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nirit Soffer-Dudek
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tadas Stumbrys
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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2
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Carr M, Youngren W, Seehuus M, Semin R, Angle E, Pigeon WR. The Effects of Lucid Dreaming and Nightmares on Sleep Quality and Mental Health Outcomes. Behav Sleep Med 2025; 23:133-140. [PMID: 39545370 DOI: 10.1080/15402002.2024.2423297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
OBJECTIVES This study aimed to investigate relationships between lucid dreaming and sleep and mental health outcomes within a representative sample of the general population. We also sought to examine how nightmares interact with the relationship between lucid dreaming, sleep, and mental health outcomes. METHODS Participants (N = 1332) completed measures of lucid dream frequency, nightmare frequency, anxiety and depressive symptoms, stress, and sleep quality. Hierarchical regression models were conducted, where step-1 examined the direct effect of lucid dreaming on all outcome variables, and step-2 added nightmares into the equation (to examine direct effects of lucid dreaming frequency and nightmares, and the indirect effect of nightmares). RESULTS Step-1 results demonstrated that lucid dreaming positively predicted poor sleep quality, stress, anxiety, and depressive symptoms. Step-2 results revealed that nightmares were the only significant predictor of poor sleep quality, stress, and anxiety symptoms, accounting for all of the variance of lucid dreaming. Nightmares and the interaction of nightmares and lucid dreaming positively predicted depressive symptoms. CONCLUSIONS Our results suggest that nightmares alone explain associations between lucid dreaming and poor sleep quality, anxiety symptoms, and stress. However, both nightmares and the combination of nightmares and lucid dreaming are associated with increased depressive symptoms.
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Affiliation(s)
- Michelle Carr
- Department of Psychiatry and Addictology,University of Montreal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montreal, QC, Canada
| | - Westley Youngren
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Martin Seehuus
- Psychology Department, Middlebury College, Middlebury, VT, USA
- Vermont Psychological Services, University of Vermont, Burlington, VT, USA
| | - Raphaëlle Semin
- Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Emma Angle
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- US Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
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3
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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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Foffani G. To be or not to be hallucinating: Implications of hypnagogic/hypnopompic experiences and lucid dreaming for brain disorders. PNAS NEXUS 2024; 3:pgad442. [PMID: 38178978 PMCID: PMC10766414 DOI: 10.1093/pnasnexus/pgad442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
The boundaries between waking and sleeping-when falling asleep (hypnagogic) or waking up (hypnopompic)-can be challenging for our ability to monitor and interpret reality. Without proper understanding, bizarre but relatively normal hypnagogic/hypnopompic experiences can be misinterpreted as psychotic hallucinations (occurring, by definition, in the fully awake state), potentially leading to stigma and misdiagnosis in clinical contexts and to misconception and bias in research contexts. This Perspective proposes that conceptual and practical understanding for differentiating hallucinations from hypnagogic/hypnopompic experiences may be offered by lucid dreaming, the state in which one is aware of dreaming while sleeping. I first introduce a possible systematization of the phenomenological range of hypnagogic/hypnopompic experiences that can occur in the transition from awake to REM dreaming (including hypnagogic perceptions, transition symptoms, sleep paralysis, false awakenings, and out-of-body experiences). I then outline how metacognitive strategies used by lucid dreamers to gain/confirm oneiric lucidity could be tested for better differentiating hypnagogic/hypnopompic experiences from hallucinations. The relevance of hypnagogic/hypnopompic experiences and lucid dreaming is analyzed for schizophrenia and narcolepsy, and discussed for neurodegenerative diseases, particularly Lewy-body disorders (i.e. Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies), offering testable hypotheses for empirical investigation. Finally, emotionally positive lucid dreams triggered or enhanced by training/induction strategies or by a pathological process may have intrinsic therapeutic value if properly recognized and guided. The overall intention is to raise awareness and foster further research about the possible diagnostic, prognostic, and therapeutic implications of hypnagogic/hypnopompic experiences and lucid dreaming for brain disorders.
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Affiliation(s)
- Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid 28938, Spain
- Hospital Nacional de Parapléjicos, Toledo 45004, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid 28031, Spain
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5
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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: 0.5] [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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6
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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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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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8
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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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9
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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: 9] [Impact Index Per Article: 3.0] [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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10
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García-Campayo J, Moyano N, Modrego-Alarcón M, Herrera-Mercadal P, Puebla-Guedea M, Campos D, Gascón S. Validation of the Spanish Version of the Lucidity and Consciousness in Dreams Scale. Front Psychol 2021; 12:742438. [PMID: 34744915 PMCID: PMC8566340 DOI: 10.3389/fpsyg.2021.742438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Lucid dreaming, a specific phenomenon of dream consciousness, refers to the experience being aware that one is dreaming. The primary aim of this research was to validate a Spanish version of the Lucidity and Consciousness in Dreams scale (LuCiD). A secondary aim was to explore whether meditation experience and mindfulness trait were related to LuCiD scores. Data from 367 Spanish men (34.6%) and women (65.4%) who completed LuCiD, the Five Facets of Mindfulness Questionnaire (FFMQ), and the Positive and Negative Affect Schedule (PANAS) were examined. From the total sample, 40.3% indicated some experience with formal meditation (meditators), while 59.7% did not have any meditation experience (non-meditators). A random subsample of 101 participants, who completed LuCiD for a second time after a period of 10–15days, was used for test–retest reliability analysis. The LuCiD scale comprises 28 items distributed across eight factors: insight, control, thought, realism, memory, dissociation, negative emotion, and positive emotion. Factor structure, reliability by both internal consistency and test–retest reliability, and construct and concurrent validity were tested. Confirmatory factor analysis (CFA) confirmed the original eight-factor model, showing goodness of fit in contrast to a single-factor model. Item 15 was deleted from the Dissociation factor as it performed poorly (i.e., skewness and kurtosis, non-normal distribution of responses, and corrected item–total correlation under 0.40). The scale showed adequate values of internal consistency (between α=0.65 for Memory and α=0.83 for Positive Emotion) and test–retest reliability by significant Pearson correlations (p<0.001) for each factor. The scores of meditators were higher for the LuCiD scale Insight and Dissociation factors, in contrast to those of non-meditators. The Observing facet of mindfulness was positively associated with all LuCiD factors, except Realism and Positive Emotion, and the Acting with Awareness facet showed a negative correlation with the LuCiD factor Realism. Finally, positive and negative affects was associated with the LuCiD factors Positive Emotion and Negative Emotion. This study provides a valid and reliable measure for exploring lucidity and consciousness in dreams for a Spanish population, Moreover, the results suggest a relationship with meditation experience, mindfulness trait, and positive and negative affect.
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Affiliation(s)
- Javier García-Campayo
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, Madrid, Spain.,Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Nieves Moyano
- Department of Psychology, Faculty of Humanities and Educational Sciences, University of Jaén, Jaén, Spain
| | - Marta Modrego-Alarcón
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Paola Herrera-Mercadal
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Marta Puebla-Guedea
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Social and Labor Sciences, University of Zaragoza, Zaragoza, Spain
| | - Daniel Campos
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Santiago Gascón
- Department of Psychology and Sociology, Faculty of Social Sciences and Humanities, University of Zaragoza, Teruel, Spain
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11
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Abstract
Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Variations in circadian rhythm genes might be involved in their pathogenesis. Predisposing factors include sleep deprivation, irregular sleep-wake schedules, and jetlag. The most effective therapy consists of avoiding those factors.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck (MUI), Anichstrasse 35, 6020, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck (MUI), Anichstrasse 35, 6020, Innsbruck, Austria.
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12
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O'Regan D, Nesbitt A, Biabani N, Drakatos P, Selsick H, Leschziner GD, Steier J, Birdseye A, Duncan I, Higgins S, Kumari V, Stokes PR, Young AH, Rosenzweig I. A Novel Group Cognitive Behavioral Therapy Approach to Adult Non-rapid Eye Movement Parasomnias. Front Psychiatry 2021; 12:679272. [PMID: 34276446 PMCID: PMC8281294 DOI: 10.3389/fpsyt.2021.679272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Following the success of Cognitive Behavioral Therapy (CBT) for insomnia, there has been a growing recognition that similar treatment approaches might be equally beneficial for other major sleep disorders, including non-rapid eye movement (NREM) parasomnias. We have developed a novel, group-based, CBT-program for NREM parasomnias (CBT-NREMP), with the primary aim of reducing NREM parasomnia severity with relatively few treatment sessions. Methods: We investigated the effectiveness of CBT-NREMP in 46 retrospectively-identified patients, who completed five outpatient therapy sessions. The outcomes pre- and post- CBT-NREMP treatment on clinical measures of insomnia (Insomnia Severity Index), NREM parasomnias (Paris Arousal Disorders Severity Scale) and anxiety and depression (Hospital Anxiety and Depression Scale), were retrospectively collected and analyzed. In order to investigate the temporal stability of CBT-NREMP, we also assessed a subgroup of 8 patients during the 3 to 6 months follow-up period. Results: CBT-NREMP led to a reduction in clinical measures of NREM parasomnia, insomnia, and anxiety and depression severities [pre- vs. post-CBT-NREMP scores: P (Insomnia Severity Index) = 0.000054; P (Paris Arousal Disorders Severity Scale) = 0.00032; P (Hospital Anxiety and Depression Scale) = 0.037]. Improvements in clinical measures of NREM parasomnia and insomnia severities were similarly recorded for a subgroup of eight patients at follow-up, demonstrating that patients continued to improve post CBT-NREMP. Conclusion: Our findings suggest that group CBT-NREMP intervention is a safe, effective and promising treatment for NREM parasomnia, especially when precipitating and perpetuating factors are behaviorally and psychologically driven. Future randomized controlled trials are now required to robustly confirm these findings.
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Affiliation(s)
- David O'Regan
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Alexander Nesbitt
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Department of Neurology, Guy's Hospital, London, United Kingdom
| | - Nazanin Biabani
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Panagis Drakatos
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Hugh Selsick
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Insomnia Clinic, Royal London Hospital for Integrated Medicine, London, United Kingdom
| | - Guy D Leschziner
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Department of Neurology, Guy's Hospital, London, United Kingdom.,Basic and Clinical Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Joerg Steier
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Adam Birdseye
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom
| | - Iain Duncan
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom
| | - Seán Higgins
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Department of Neuroimaging, Sleep and Brain Plasticity Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Veena Kumari
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Paul R Stokes
- Department of Psychological Medicine, King's College London & South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, King's College London & South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Ivana Rosenzweig
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, United Kingdom.,Department of Neuroimaging, Sleep and Brain Plasticity Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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13
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Holzinger B, Mayer L, Barros I, Nierwetberg F, Klösch G. The Dreamland: Validation of a Structured Dream Diary. Front Psychol 2020; 11:585702. [PMID: 33178086 PMCID: PMC7596900 DOI: 10.3389/fpsyg.2020.585702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
Validated instruments for the analysis of dream contents are still scarce. Therefore, the aim of this study was to validate the Dreamland Questionnaire (DL-Q) by comparing its results to those of the Hall and van de Castle Coding System (HVDC). Twenty-two participants voluntarily filled in a written dream report as well as our DL-Q questionnaire, in total 30 dreams were collected with both measures. Written reports were analyzed with the HVDC and results of the two instruments were compared using Pearson correlations. Results showed that correlations were high for dominant characters, pleasantness of dream content, and body-related experiences. However, some DL-Q items showed low correlations and others could not be compared directly, as the HVDC did not include the same set of items. The DL-Q showed satisfactory validity and reliability as a measure of dream criteria and may serve as an effective tool for diagnosis and evaluation and facilitate future clinical and research studies. Nevertheless, some items could not be compared as part of this study and should be validated in future investigations.
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Affiliation(s)
| | - Lucille Mayer
- Institute for Consciousness and Dream Research, Vienna, Austria
| | - Isabel Barros
- Psychology Department, California State University, Long Beach, CA, United States
| | | | - Gerhard Klösch
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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14
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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: 1.6] [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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15
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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: 9] [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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16
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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: 0.8] [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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17
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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: 11] [Impact Index Per Article: 2.2] [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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18
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Drinkwater KG, Dagnall N, Denovan A. Dark Triad Traits and Sleep-Related Constructs: An Opinion Piece. Front Psychol 2020; 11:505. [PMID: 32265801 PMCID: PMC7096540 DOI: 10.3389/fpsyg.2020.00505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
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19
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Holzinger B, Levec K, Munzinger MM, Mayer L, Klösch G. Managing daytime sleepiness with the help of sleepcoaching, a non-pharmacological treatment of non-restorative sleep. Sleep Breath 2019; 24:253-258. [PMID: 31853836 PMCID: PMC7127987 DOI: 10.1007/s11325-019-01995-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/13/2022]
Abstract
Purpose To measure the effect of a 2-day sleepcoaching seminar on daytime sleepiness and sleep-related variables of shift workers employed in an Austrian railway company (ÖBB: Österreichische Bundesbahnen). Method Participants filled in pre- and post-intervention questionnaires, containing items of the PSQI and the ESS, questions about chronotype, personality factors and possible burnout risk factors. About 30 shift workers, working in shifts for more than 300 months on average (28 male; mean age = 24 ± 45.90, age range 24–56 years) voluntarily took part in the investigation twice. Sleep coaching by Holzinger and Kloesch™ (SC) is a new holistic approach for non-pharmacological treatment of non-restorative sleep and is based on Gestalt therapy. It includes psychotherapeutic aspects, which enable clients to improve their sleep quality by developing one’s own coping strategies which can be implemented in daily routine. Dream work and relaxation techniques are also part of the programme. Results The 2-day SC seminar was beneficial by focusing on the sleep problems related to shift work. A significant improvement of the global PSQI score and the PSQI variables subjective sleep quality, diurnal fatigue, and sleep latency was achieved, with a medium effect size. However, the programme did not result in the reduction of daytime sleepiness (ESS). Six more variables did not change significantly. Conclusion While some sleep problems related to shift work were successfully addressed by SC, daytime sleepiness (ESS) could not be reduced contrary to our expectations. More research with a greater sample and a longitudinal design is needed to examine the long-term effects of SC.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Canongasse 13/, 1A-1180, Vienna, Austria.
- Medical University, Vienna, Austria.
| | - Katharina Levec
- Institute for Consciousness and Dream Research, Canongasse 13/, 1A-1180, Vienna, Austria
| | | | - Lucille Mayer
- Institute for Consciousness and Dream Research, Canongasse 13/, 1A-1180, Vienna, Austria
| | - Gerhard Klösch
- Institute for Consciousness and Dream Research, Canongasse 13/, 1A-1180, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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20
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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: 3.5] [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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21
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Schimmenti A, Somer E, Regis M. Maladaptive daydreaming: Towards a nosological definition. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2019.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Sleep coaching: non-pharmacological treatment of non-restorative sleep in Austrian railway shift workers. Arh Hig Rada Toksikol 2019; 70:186-193. [PMID: 32597126 DOI: 10.2478/aiht-2019-70-3244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Sleep coaching by Holzinger & Klösch™ is a new, Gestalt therapy-based holistic approach to non-pharmacological treatment of non-restorative sleep. It includes psychotherapeutic aspects which enable participants to improve their sleep quality by developing their own coping strategies as a daily routine. Dream work and relaxation techniques are also part of the programme. The aim of this study was to measure the effectiveness of a two-day sleep coaching seminar on sleep quality, daytime sleepiness, and work and life quality in shift workers employed in an Austrian railway company (Österreichische Bundesbahnen, ÖBB). Thirty shift workers (28 male; mean age=24±45.90, age range 24-56 years) answered the same survey before and six months after the seminar (baseline and follow-up) containing items of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), their chronotype, personality factors, and burnout risk factors. The baseline findings in this group were compared with those of non-completers (who did not take the follow-up survey) (N=154) to see if the two groups differed significantly enough to create a bias among completers (who took the follow-up survey as well). Groups differed significantly in burnout levels as well as sleep duration, but not in the distribution of critical PSQI and ESS values. The two-day sleep coaching seminar resulted in a significant improvement in total PSQI score and subjective sleep quality and in a significant reduction in diurnal fatigue, sleep latency, and daytime sleepiness. Nevertheless, more research with a larger sample and a longitudinal design is needed to establish the long-term effects of sleep coaching.
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23
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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: 76] [Impact Index Per Article: 12.7] [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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24
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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: 114] [Impact Index Per Article: 19.0] [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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25
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Seeman MV. Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia. World J Psychiatry 2018; 8:75-78. [PMID: 30254976 PMCID: PMC6147773 DOI: 10.5498/wjp.v8.i3.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023] Open
Abstract
Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask about nightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in non-schizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada
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26
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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: 1.6] [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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27
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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: 113] [Impact Index Per Article: 16.1] [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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Aspy DJ, Madden NA, Delfabbro P. Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep. Percept Mot Skills 2018; 125:451-462. [PMID: 29665762 DOI: 10.1177/0031512518770326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anecdotal evidence indicates that supplementation with vitamin B6 (pyridoxine) before bed can enhance dream vividness and recall. In a single pilot study, Ebben, Lequerica, and Spielman (2002) found that vitamin B6 had a dose-dependent effect of increasing scores on a composite measure of dream vividness, bizarreness, emotionality, and color. The present research replicated this study using a larger and more diverse sample of 100 participants from across Australia. We conducted a randomized, double-blind, placebo-controlled investigation of the effects on dreaming and sleep of ingesting 240 mg vitamin B6 (pyridoxine hydrochloride) before bed for five consecutive days. We also included an exploratory condition involving a B complex preparation containing a range of B vitamins. We found that vitamin B6 significantly increased the amount of dream content participants recalled but did not significantly affect dream vividness, bizarreness, or color, nor did it significantly affect other sleep-related variables. In contrast, participants in the B complex group showed significantly lower self-rated sleep quality and significantly higher tiredness on waking. We discuss the potential for using vitamin B6 in research on lucid dreaming.
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Affiliation(s)
- Denholm J Aspy
- 1 School of Psychology, The University of Adelaide, SA, Australia
| | - Natasha A Madden
- 2 216982 Endeavour College of Natural Health, Adelaide SA , Australia
| | - Paul Delfabbro
- 1 School of Psychology, The University of Adelaide, SA, Australia
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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: 34] [Impact Index Per Article: 4.3] [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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Rousseau A, Belleville G. The mechanisms of action underlying the efficacy of psychological nightmare treatments: A systematic review and thematic analysis of discussed hypotheses. Sleep Med Rev 2017; 39:122-133. [PMID: 29056416 DOI: 10.1016/j.smrv.2017.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/06/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022]
Abstract
Studies of psychotherapeutic treatments for nightmares have yielded support for their effectiveness. However, no consensus exists to explain how they work. This study combines a systematic review with a qualitative thematic analysis to identify and categorize the existing proposed mechanisms of action (MAs) of nightmare treatments. The systematic review allowed for a great number of scholarly publications on supported psychological treatments for nightmares to be identified. Characteristics of the study and citations regarding potential MAs were extracted using a standardized coding grid. Then, thematic analysis allowed citations to be grouped under six different categories of possible MAs according to their similarities and differences. Results reveal that an increased sense of mastery was the most often cited hypothesis to explain the efficacy of nightmare psychotherapies. Other mechanisms included emotional processing leading to modification of the fear structure, modification of beliefs, restoration of sleep functions, decreased arousal, and prevention of avoidance. An illustration of the different variables involved in the treatment of nightmares is proposed. Different avenues for operationalization of these MAs are put forth to enable future research on nightmare treatments to measure and link them to efficacy measures, and test the implications of the illustration.
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Holzinger B. Albträume: Ätiologie, Prävalenzen, gesundheitliche Folgen und Behandlungsansätze. SOMNOLOGIE 2015. [DOI: 10.1007/s11818-015-0026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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