Treating nightmares - application examples and backgrounds
Nightmares are an important and underestimated problem in psychotherapy. But today there are well-founded approaches that do not "treat" these dreams, as was previously the case, only as a side effect of traumatizations or mental disorders.
Work on nightmares has always played a special role in the treatment of traumas, as they are a key symptom of post-traumatic stress disorder. Those affected not only find it difficult to differentiate between dream reality and external reality, their nightmares also occur frequently, and the associated feelings have an intense effect on the waking state.
In people without this disorder, there are different theories about the nocturnal hell trips. There are indications that stressful situations with which we do not deal adequately during the day push into our dreams.
Another theory assumes that the nightmares continue what we do during the day. Findings from the latest brain research are promising. Accordingly, the brain actively works to solve problems during the dream. Nightmares would therefore not be a superfluous troublemaker, but a painful but necessary mental work on real problems and real conflicts. The horror trip would even have a therapeutic function by helping us to deal with fears or to design solutions for existential situations.
On the other hand, it is contradicted that a nightmare is defined by the fact that the event scares us so much that we wake up from it, and that does not lead to a problem being solved in the dream. Lasting nightmares do not lead to a better handling of everyday life - on the contrary. Those affected are afraid of falling asleep, they do not regenerate during sleep and suffer from tiredness during the day.
The behavioral therapies
Behavioral therapies are practically oriented. They assume that life problems in the wake of mental disorders cannot be solved by analyzing them again and again, but rather by the fact that those affected change their behavior in stressful situations.
That is why behavioral therapists do not go through every dream in detail in order to decrypt "hidden messages". What is important for them, on the other hand, is whether certain situations occur again and again in nightmares and which situations correspond to them in everyday life.
Then it is a matter of the patient changing his behavior in precisely these situations and the situation losing its sting. Is there a real conflict in the dream? If not, then behavioral therapy is about getting nightmares under control and giving those affected a higher quality of life.
Confrontation therapy for nightmares
Confrontation therapy, which overlaps with therapeutic writing, therapeutic painting and other methods of recognizing oneself, shows success. The patients write down their nightmare, read it out loud to themselves and the therapist several times in succession. You should allow the negative feelings that arise and talk about them.
They talk about these negative feelings until they eventually become less and at best disappear. Dr. Renate Daniel from C.G. Jung Institute in Zurich advises: "It definitely helps to discuss the nightmare with someone and learn to understand them." According to the expert, conflicts should be considered and a solution sought, because in her experience the difficulties would not go away from everyone. It is advisable for those affected to see how he / she can deal with the problem - because just dealing with the topic calms the soul.
However, it is not an obligation to talk to another person about dreams, emphasizes Dr. Daniel. Writing everything down can also help, because most of the time, the experience only has to be put into words or recorded, explains Daniel. Then it could even be enough if the records were put in a drawer.
Imagery Rehearsal Therapy
This active imagination goes a step beyond confronting the oppressive images. This is not just about raising awareness of nightmares, but actively changing them.
Those affected not only write down the contents of their dream, but relax and take the pictures to their minds. In the case of recurring dreams, it helps to keep a dream diary and thus become more and more clear about the images that occur.
The patients now change the content of their imagination until the stressful elements have lost their terror. This method is ideal for people who have a lively imagination anyway.
It is particularly important when dreams indicate real conflicts. Then it even promotes better handling of these real problems. It is not in conflict with brain research, but applies its findings in practice. If nightmares are actually problematic work, then they do this work insufficiently when they in turn trigger problems.
Imagination therapy helps the night work to a certain extent. If the nightmares offer the raw material by showing stressful situations, the person concerned consciously works through these situations.
It doesn't have to be the real situation at all, just a visual expression of it. For example, if I dream about a general sending me to the front where grenades tear my intestines, and I change the content so that I say no, and the general has no power over me, this could happen plant in my unconscious that I also say no in real situations when people make unreasonable demands on me.
The nightmare researcher Reinhard Pietrowsky sees it as useful if the therapist participates in the interpretation of the dream images, but warns against generalizations as they are widespread in the esoteric scene and among "miracle healers". According to the expert, the interpretation of dreams could make sense for therapy - but rather as a starting point for important topics and "not so flat that one can conclude from spider dreams about the fear of a dominant mother".
According to Dr. Renate Daniel is the most common nightmare motive to be followed. Now the questions are: What part of the soul is it that is pursuing me? What exactly is haunting me? Is it a feeling of guilt or the past, old beliefs or behavior patterns? Does the dream have anything to do with me? Am I repressing that a relationship is not going to work? Who is chasing me or what am I running away from? Are they things that embarrass me? Answering these questions is already a big step on the way to solving them.
When does nightmare therapy make sense?
If you suffer from chronic nightmares, therapy is highly recommended. You are like someone whose roof is dripping with water and who lack the simple tools to plug the hole.
Nightmares are just as difficult as the methods to get them under control are easy to learn. If there are no deeper disorders, for example dreams are the expression of severe depression, the quality of life of those affected will improve after just a few sessions. The bad dreams disappear, the sleep is relaxing again, the patients are fitter, they have more energy and feel better.
Dr. Renate Daniel reports on a particularly dramatic case in which the victim sought therapeutic help decades too late. It was a 75-year-old woman who had never had any contact with psychotherapy. The daughter had now sent her mother because she had had nightmares since she was 15 years old - that is, for 60 years. The patient had given up hope of help due to the long time, but after about 15 therapy sessions the nightmares finally stopped. “It didn't take too long for the soul to calm down. I was very impressed that working on this chronic problem was relatively easy, ”said Dr. Daniel.
Compensation or corrective?
In 1934, Ferenczi saw dreams fundamentally as an attempt to cope with traumatic experiences psychologically. Carl Gustav Jung kept all dreams, including nightmares, as a means of the psyche to control oneself and to compensate and correct experiences.
Accordingly, the nightmare just compensates for the proportions of personality that the dreamer denies in waking life. The more someone denies his embarrassing share, the more drastically his dreams point this out to him.
This is countered by the continuity hypothesis. She suspects that nightmares continue the waking life. The fears of the awake person are therefore also the fears that he has in a dream.
Jung did not simply assume that someone always dreams of exactly the opposite of what he focuses on in his waking life. An overly optimistic person doesn't have nightmares to show him that not everything is covered in pink clouds.
Rather, according to Jung, a dream can also grotesquely exaggerate the one-sided fixations. The negative thoughts of a cultural pessimist who assumes that society is going down the drain anyway could turn into a nightmare at night, in which apocalyptic monsters devastate the world and show him that his view of the world is exaggerated.
The dream script
Dream therapy is based on the fact that nightmares that come back are stored in the brain as a script. At the same time, this script is not closely linked to autobiographical memory; Those affected perceive above all negative emotions, which are also repeated in the day's thoughts, but receive little concrete information if it is a concrete experience that is behind it.
The REM phase of sleep is characterized by a high degree of images that in dreams become more or less related stories. And to put it bluntly, the script in the brain is now taking the form of a comic. The more the nightmare repeats itself, the stronger the saved pattern becomes, because the connections of our synapses strengthen the familiar. In addition, the intensity of the dream strengthens the process.
At the same time, certain personality traits, such as neuroses, "thin skin", high sensitivity or depression lead to the stress that the dream in question triggers. In turn, distorted perceptions and unhealthy behavior prevent the brain from excluding the script.
On the one hand, this includes perceptions of people for whom nightmares are part of far-reaching affective disorders. Those who suffer from psychoses and who are tormented by paranoid delusions, who are driven by fear of persecution at night and during the day, are hardly able to distance themselves from the negative emotions.
Also at risk are people who misinterpret the sensible advice to make the dream happen aware as "to let themselves fall into the feelings of the dream". If you go into negative feelings such as fear of death, anger or despair without reflection, they will become stronger and at some point become a habit without alternatives.
Old dreams and fear
Research into whether nightmare and anxious personality are related has given different results. A direct connection has not yet been established - but there is a connection between diagnosed anxiety disorders and repeated nightmares, which are a symptom of these psychological complaints.
A connection between people with "thin borders", that is highly sensitive and frequent nightmares, is clearer. Such people have a high permeability between reality, fantasy, daydream and dream. They are open, their relationships are as intense as they are conflict-ridden, they react intensely to criticism and think a lot about the problems of their fellow human beings, sometimes so strongly that the problems of others become their own.
Such people have great imagination, are easily hypnotized and easy to inspire. They are often extraordinarily creative and have direct access to their inner world of images - they paint often or write fantastic stories.
Those affected often take dreams very seriously and have a strong understanding of dream symbols. They are also sensitive to physical stimuli such as smells, light or noise. Sometimes, in the hour after waking up, you can hardly distinguish between dream, fantasy and reality.
These people have intense and frequent nightmares; but this is not generally because they generally have more negative feelings than people who do not dream like that, but rather they dream intensively and frequently. Your entire dream world is extremely active, and with it you experience massive nightmares.
Creativity and nightmares
Connected to thin-skinned, but not identical, is creativity. Particularly creative people often remember their dreams and experience imaginative stories in them, or maybe because of that many and often bizarre nightmares.
The following applies here: because they experience a blossoming dream world as a whole, they have more beautiful dreams than nightmares.
Gestalt therapy according to Pearls sees itself at the interface between therapy, theory and phiosophy. The basic idea is that the whole is more than the sum of its parts. Pearls assumed that dreams contain important clues from a person about themselves that, however, have to be decrypted.
The dream does not necessarily contain the solution of a problem, but would often only show the problem. Dream figures, events and shapes would show aspects of the dreaming.
The difference to psychoanalysis is that the therapist is not the one who analyzes the dream. Rather, it accompanies the dreaming. The dreaming himself designs the dream work. It is essential to activate the dream experience.
Role playing and hot chair
The Gestalt therapy methods include, for example, psychoactive role-playing games and the “hot chair” where one participant tells their dreams and the others listen. In this way, the contents should become clear in dialogue.
Instead of "only" analyzing the dream, Gestalt therapy asks to play and express the content, since it expresses alternative behavior, psychological restructuring and the needs of the person concerned.
Therapists also use relaxation techniques to relieve nightmares. This is about increasing the threshold at which they are triggered by reducing the stress of those affected.
These procedures include progressive muscle relaxation, which Edmund Jacobson developed specifically for anxiety disorders. Autogenic training, meditation or yoga can also help with relaxation therapy.
Relaxation techniques alone are not enough to deal with dreams, as they only reduce the trigger stress. However, they can be a good addition to other therapies, especially for people who are acutely affected, comparable to a headache pill that relieves the symptoms.
Reducing stress is also the motive for conditioning procedures and psycho-education. This includes information about nutrition, exercise, the sleeping environment, stimulants and strategies for coping with stress.
Although there are no studies to prove the effectiveness of sleep hygiene in nightmares, it is plausible to assume that undisturbed sleep is also helpful for nightmare therapy.
Some dreams actually have to do with such external circumstances. For example, those who devour excessively heavy meals before falling asleep could dream, for example, of being unable to move.
Education, for example, means giving those affected information about the genesis of nightmares and their frequency and intensity in order to relieve them.
Exposure therapy assumes that nightmares can increase like any other behavior, but also become weaker or disappear. They are similar to triggers that trigger anxiety.
Those affected continue to confront the nightmare until it no longer instills fear in them. The therapist and patient first find out the scary elements. Then the patient is desensitized to these elements, for example by relaxing the dreaming. When he is relaxed, he imagines parts of the nightmare until he can imagine the entire dream without fear.
Studies have shown that this systematic desensitization is superior to relaxation methods.
Self-exposure turns into therapeutic writing. The dreamers write down their nightmares here and then imagine them again. In contrast to systematic desensitization, this imagination does not run gradually and relaxation techniques are lacking.
Exposure therapies lead to fewer, weaker, or no nightmares. One disadvantage, however, is that it is a burden for the patient to face the fearful dream situation. Many patients are therefore not exposed to such therapy and have to resort to other methods.
Caution should be exercised in patients with post-traumatic nightmares. An exposure can harm here, because it would amount to a dream confrontation, but without being able to offer the appropriate framework. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
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