Nightmares Are Treatable

Nightmares are easily treatable, though too few seek help.

Taken together, the nightmare studies presented at the recent (June 2019) conference for the International Association for the Study of Dreams (IASD) offer compelling reasons for those who suffer from nightmares to seek any kind of treatment, and as soon as possible. The studies suggest that virtually all nightmare treatments are effective and that the earlier nightmare disorder is treated the better. Current nightmare research was presented at an international dream conference held in a 900-year-old abbey in Kerkrade, The Netherlands. In this post, I will summarize the nightmare studies of greatest clinical relevance.

Michael Schredl conducted a four-year longitudinal study on nightmares and stress and found that nightmare frequency is generally stable from childhood onwards. He thinks nightmares may be due to emotional regulation issues rather than genetics. He said what increases nightmare frequency and distress is a rise in current anxiety and stress levels (vs. trait stress). Frequent nightmares in the past also predict frequent nightmares in the future. In terms of clinical implications, Schredl suggested that for those who suffer from frequent distressing nightmares, the earlier they seek treatment, the better.

Sadly, very few people seek help for their nightmares. Kateřina Surovcová conducted a qualitative study of the experiences of social dream sharing of nightmares. She noted that only one in 8 people seek help for their nightmares despite their detrimental effects. People are reluctant to share nightmares for fear of being seen as crazy and because they don’t want to burden others with the darkness of their dreams. Yet talking about nightmares can bring a welcome sense of relief.

Another recent study, a randomized controlled trial by Carolin Schmid which compared two established imagery-based treatments, showed that all treatments are effective at reducing nightmare frequency and distress, even the control condition! For the many people who leave their nightmares untreated, it might help to know that virtually all treatment options are likely to be effective.

In the study, Schmid compared three different imagery-based methods. The first is imagery rehearsal therapy (IRT) which asks the client to imagine a new ending to their distressing dream and then rehearse it. The second is exposure therapy, in which the client is repeatedly exposed to their nightmare imagery. The third, an active rather than waitlist control, guides clients to imagine a safe place. Interestingly, all three methods worked equally well, and all worked with just one treatment session. So, in treating nightmares, it really is true that any treatment is better than no treatment, and the resulting decrease in nightmare frequency and distress occurs after just one treatment.

Schredl noted that in nightmare studies and clinical treatment, the distress caused by the nightmare is the most important variable, and the frequency is of secondary importance. He said people’s attitudes toward their nightmares matters. This is another area where clinical intervention can be very helpful. I can offer a personal example from my practice, an approach useful to any therapist wondering how to approach a challenging nightmare.

The images in nightmares can be gruesome and upsetting. However it helps to suggest to those who experience such dreams that the images are not meant to be taken literally, and that they may even be referring to something dramatically positive. Popular dreamworker Jeremy Taylor saw dream images of death, for example, as indicating a major transformation such as the cessation of an addiction. A client of mine dreamt of dismembering a woman, and this image lost its disturbing quality once she considered the ways she felt profoundly divided in her own life and could see the image as an apt metaphor for this.

In my practice, I aim to encourage people who have nightmares to explore them with open curiosity, and in the course of experiential exploration, to befriend the dream images as much as possible. This shifts the dreamer’s attitude toward their nightmares, and as a result, they can often find them less distressing. This is one way to work with nightmares; what the research suggests is that almost anything works. So as a clinician, there is no need to shy away from dreamwork with clients who have nightmares, and in fact, good reasons to forge ahead.

Master an engaging, experiential way to talk about dreams with your clients by taking Leslie Ellis’ course How to Work with Dreams in Your Clinical Practice here on JungPlatform. You will also learn how the current science of dreaming supports its use and how to make the most of the healing potential inherent in your clients’ dreams.