The prevalence of nightmares and their independence from anxiety.

Although several studies have examined the prevalence of nightmares and their relationship to anxiety, this is the first to have used daily dream logs, rather than retrospective self-reports, to monitor nightmare frequency. 220 undergraduates were administered self-report measures of anxiety and for 2 weeks recorded the number of their nightmares in logs. 47% of Ss reported at least one nightmare during the study period. The dream logs yielded an estimated mean annual nightmare frequency of 23.6, which is 2.5 times as great as the estimate yielded by retrospective reports (p?     

Adaptation of imagery rehearsal therapy for nightmares in children: A brief report.

This study investigated the effectiveness of a psychotherapeutic treatment for nightmares that was adapted for 6- to 11-year-old children from imagery rehearsal therapy. Ten child–mother dyads took part in a 3-session, 8-week treatment protocol. Participation in the study (contact with clinician, keeping a prospective dream log) was associated with decreases unpleasant dreams frequency, nightmare distress, and manifest anxiety. Providing educational information about nightmares did contribute to this positive effect. Results also suggest that drawing modified versions of nightmares for 1 month was associated with further reductions in nightmare distress and anxiety, but with no changes in unpleasant dreams frequency. Follow-ups at 3 and 6 months posttreatment suggest that the intervention had maintained effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of nightmares via relaxation and desensitization: A controlled evaluation.

32 self-referred nightmare sufferers (mean age 36 yrs) were randomly assigned to relaxation training, systematic desensitization, or a waiting-list control. Ss on the average had been having 9 nightmares/mo and reported mean problem duration of 12 yrs prior to treatment. After the intervention phase, both treated groups showed significant decreases in nightmare frequency relative to controls. After subsequent treatment, the waiting-list group showed similarly decreased frequency but remained unimproved on nightmare intensity relative to prior treated groups. Hierarchical desensitization did not increase efficacy at 15 wks beyond benefits associated with relaxation alone. At 25 wks, however, desensitized Ss showed significantly greater reduction in nightmare intensity. Overall, at least 80% reduction in nightmares was reported by 20 Ss, of whom 12 reported total elimination of symptoms at 25-wk follow-up. Some Ss experienced fewer but more intense nightmares, others maintained frequency of previously disturbing dreams but were no longer awakened or distressed by them, and 2 reported substantial worsening of symptoms. Unfavorable outcome was associated with personality disorder profiles on the MMPI. Findings are discussed in relation to a conceptualization of nightmares as a symptom of a more generalized arousal disorder. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nightmares and bad dreams: Their prevalence and relationship to well-being.

This study, for the first time, distinguishes between nightmares and bad dreams, measures the frequency of each using dream logs, and separately assesses the relation between nightmares, bad dreams, and well-being. Eighty-nine participants completed 7 measures of well-being and recorded their dreams for 4 consecutive weeks. The dream logs yielded estimated mean annual nightmare and bad-dream frequencies that were significantly (ps?     

Nightmare prevalence in the healthy elderly.

51 healthy elderly Ss (median age 65 yrs) gave retrospective estimates of nightmare frequency in questionnaires and recorded the occurrence of nightmares in daily logs over a 2-wk period. Mean annual nightmare frequency as estimated from logs was only 65% as high among college student controls. Elderly Ss were about –1/? as likely as college students to report a problem with nightmares. Frequency estimates on the basis of logs were over 10 times higher than retrospective estimates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ego boundary impairment and thought disorder in frequent nightmare sufferers.

This investigation examined the proposed relationship between nightmare frequency and ego boundary impairment (Hartmann, 1984) in a sample of female college students. Thirty frequent nightmare sufferers (at least one attack per week) and 30 controls (maximum of one nightmare per year) were compared. In order to measure ego boundary impairment, the Rorschach inkblot test was administered and scored for barrier and penetration responses (Fisher & Cleveland, 1968) and indices of thought disorder (Blatt & Ritzler, 1974). An ego boundary questionnaire developed by Hartmann and colleagues (Hartmann, 1989; Hartmann et al., 1987) was also administered. Although barrier and penetration scores did not discriminate, the frequent-nightmare subjects demonstrated more disordered thinking on the Rorschach (p     

Rat cultured astrocytes release guanine-based purines in basal conditions and after hypoxia/hypoglycemia

OBJECTIVE: To compile and assess the English-language literature on drug-induced nightmares, excluding nightmares secondary to drug withdrawal or drug-associated night terrors. DATA SOURCES: Published articles, letters, case reports, and abstracts in English were identified by MEDLINE (1966-May 1998) searches using the search term nightmares, chemically induced. Additional articles were obtained from bibliographies of retrieved articles. DATA EXTRACTION: All case reports of drug-induced nightmares were evaluated using the Naranjo algorithm for causality. Clinical studies of drugs that reported nightmares as an adverse effect were assessed for frequency of occurrence. DATA SYNTHESIS: Nightmares, defined as nocturnal episodes of intense anxiety and fear associated with a vivid, emotionally charged dream experience, are generally classified as a parasomnia. Possible pharmacologic mechanisms for drug-induced nightmares, such as REM suppression and dopamine receptor stimulation, are reviewed. However, the vast majority of therapeutic agents implicated in causing nightmares have no obvious pharmacologic mechanism. CONCLUSIONS: Assessing causality with an event such as a nightmare is difficult because of the high incidence of nightmares in the healthy population. Using qualitative, quantitative, and possible pharmacologic mechanism criteria, it appears that sedative/hypnotics, beta-blockers, and amphetamines are the therapeutic modalities most frequently associated with nightmares. These drug classes have a plausible pharmacologic mechanism to explain this effect. Dopamine agonists also have evidence of causality, with dopamine receptor stimulation as a possible pharmacologic mechanism.     

Nightmare frequency versus nightmare distress: Relations to psychopathology and cognitive style.

The hypotheses that psychopathology is related to nightmare distress but not to nightmare frequency and that cognitive style is related to nightmare frequency were examined. The sample consisted of 85 Ss (58 women and 27 men) who completed several measures: a sleep and dream inventory, SCL-90—Revised, Fear Survey Schedule-II, Beck Depression Inventory, an abbreviated version of the Harvard Group Scale of Hypnotic Susceptibility, Vividness of Visual Imagery, an absorption scale, a social desirability scale, and the Boundaries Questionnaire. The results strongly support the 1st hypothesis but only slightly the 2nd. Such findings underscore the need to differentiate nightmare frequency from suffering (waking distress associated with nightmares) and suggest that although frequency may be related to an intensification of dreaming process, suffering is related to waking emotional adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dimensional nature of disturbed dreaming: Reply to Weiss (2007).

The authors' proposed model of nightmare formation (see record 2007-06095-006) withstands several criticisms raised in an accompanying commentary article (D. S. Weiss, 2007; see record 2007-06095-007). A principal criticism, that the model lacks convergent and divergent validity, appears to stem from the commenter's application of a strong categorical, as opposed to the authors' use of a dimensional, approach to the model/construct of nightmares. Furthermore, ongoing research continues to support the authors' assumptions about the basic relationship between nightmares and affect distress. Other criticisms of the model, including a failure to account for robust epidemiological differences in nightmares and an ambiguity in the concept of affect distress, are also countered by reference to relevant research findings. A robust gender difference in nightmares (women = men) is particularly compatible with studies demonstrating gender differences in emotion among the physiological and cognitive systems that the authors propose are centrally implicated in nightmare formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of the 1989 San Francisco earthquake on frequency and content of nightmares.

In a systematic evaluation of the effects of a natural disaster on nightmares, nightmare frequency was found to be about twice as high among 92 San Francisco Bay area college students as among 97 control Ss in Tucson, Arizona, after the 1989 Loma Prieta earthquake. Ss in California had not only more nightmares in general but substantially more nightmares about earthquakes. Over a 3-wk period, about 40% of those in the San Francisco Bay area reported one or more nightmares about an earthquake, as compared with only 5% of those in Arizona. However, nightmares about earthquakes were not more emotionally intense than other nightmares. These findings support the long-held view that the experience of a potentially traumatic event can result in more frequent nightmares, particularly about the event itself, but contradict the common opinion that nightmares about such events are unusually intense. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imagery rehearsal therapy: An emerging treatment for posttraumatic nightmares in veterans.

Nightmares are a common complaint among service members exposed to traumatic events, but prevailing paradigms are disposed to a view that nightmares are a secondary phenomenon untreatable with direct therapeutic intervention. Imagery rehearsal therapy is a cognitive-imagery approach with proven efficacy in the treatment of nightmares in civilian trauma victims. Imagery rehearsal therapy not only has potential to reduce nightmare intensity and frequency, but controlled studies show clinically meaningful decreases in all clusters of posttraumatic stress disorder symptoms as well as insomnia. Limited data support its use with combat veterans. Directions for future research with combat veterans are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach assessment of annihilation anxiety and ego functioning.

This work illustrates the development, validation, and application of the Rorschach Content Scale (RCS; M. Hurvich et al; see record 1994-15961-001) for annihilation anxiety. Annihilation anxiety is defined here as the fear of one's impending psychic or physical destruction. Results reflected adequate RCS interrater reliability, content validity, construct validity, criterion validity, and divergent validity. Patient groups scored significantly higher on annihilation anxiety measures than did controls. Findings also demonstrated that certain aspects of RCS annihilation anxiety appeared more frequently than did others and may be more central to the construct. Results supported the contention that annihilation anxiety is associated with compromised ego functioning, when both are measured on the Rorschach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nightmare behavior: A review.

Reviews objective reports, surveys, observations, and studies relating to nightmare behavior. Physiological correlates of nightmares including the relationship of homeostatic imbalances and production of nightmares are examined. Investigations are criticized on the basis of inadequate numbers of Ss, absence of controls, excessive reliance on self-reports, poor reliability and validity, and lack of experimental control over independent variable under study. Possible improvements in existing methodology are considered, and suggestions for further research are offered. Psychogenic theories accounting for production of nightmare dreams are reviewed. In addition, recent applications of behavioral methodology to treatment of pathological nightmare behavior are surveyed. (49 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic moment, basic dangers and annihilation anxiety.

It is contended that the fear of being overwhelmed or annihilated is a correlate of Freud's traumatic moment, constitutes a basic danger, and should be included in the series of fear of loss of the object, loss of love, castration, and superego censure. Traumatic and signal anxiety are conceptualized as two points in a series of potential responses, and it is assumed that mental representations of the early state of helplessness (originally preverbal) can later be anticipated. Major implications of annihilation anxiety noted by Freud and later psychoanalysts are reviewed, and are found to reflect fears of disintegration of the ego and of the self. Though it has been cited many times, the concept is relatively undeveloped. Key factors which increase the likelihood of annihilation anxiety are identified as traumatic experiences, ego weaknesses, and threats to self-cohesion. The prevalence of annihilation anxieties at various levels of psychopathology, as compared with other anxiety contents, is reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of the frequent nightmare sufferer.

Previous research had found that persons who experience frequent nightmares score highly on scales that measure psychotic symptomatology. Neurotic symptoms have also been implicated as correlates of nightmare frequency. In this study, 30 adult lifelong nightmare sufferers were compared with 30 control Ss, matched for age, sex, and socioeconomic status (SES). Ss were asked to record all dreams for 1 mo and to complete the Minnesota Multiphasic Personality Inventory (MMPI) and the Eysenck Personality Questionnaire (EPQ). Nightmare Ss scored significantly higher on the EPQ Neuroticism scale and on 8 MMPI clinical scales than did the control group. These scales also best discriminated between the groups in a direct discrimination analysis. The results are interpreted as a reflection of global maladjustment rather than of specific psychotic symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipid lowering in a multidisciplinary clinic compared with primary physician management

OBJECTIVE: This study analyzed questionnaire items that address complaints about sleep from the National Vietnam Veterans Readjustment Study, a nationally representative sample of the 3.1 million men and women who served in Vietnam. This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, nonsleep posttraumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance. METHOD: The authors undertook an archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models. RESULTS: Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15.0%). In the sample of veterans who served in Vietnam (N = 1,167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57% of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after control for nonsleep PTSD symptoms. CONCLUSIONS: Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress.     

Annihilation anxiety in schizophrenia: Metaphor or dynamic?

Chronic high levels of disruptive anxiety (terror) related to annihilation fears have been observed as a pathognomonic finding in schizophrenia. It has been hypothesized that annihilation anxiety in schizophrenia is related to early traumatic interpersonal experiences and patterns of relationship that are internalized in the formation of pathological models of the world, the self, and others. The internalized traumatic experiential models of reality lead to a set of conditioned expectations that make internal and external existence painful and terrifying in relation to others. The dynamics of the compulsive schizophrenic's suicidal intent are considered in relation to helplessness and victimization, persecutory annihilation anxieties, and compliance with and escape from fantasies of annihilation. Case examples illustrating these phenomena are presented. Therapists must establish a protective and gratifying therapeutic relationship to contain the schizophrenic's annihilation anxiety or suicidal intent. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The vital role of adaptive grandiosity in artistic creativity

The artist needs adaptive grandiosity in order to create. Adaptive grandiosity is an ego-state that derives from primary narcissism and a partial resolution of the positive Oedipus complex, with the ego-ideal merged with the ego. It functions as a manic defense to overcome the artist's annihilation anxiety when confronting the blank canvas or other aspects of creativity which unconsciously represent separation from the maternal introject. Because of it fragile, defensive nature, adaptive grandiosity can readily degenerate into maladaptive grandiosity (omnipotence), which can block creativity. Clinical examples are used to illustrate the differences between adaptive grandiosity and omnipotence.     

Nightmare help: Treatment of trauma survivors with PTSD.

Describes strategies, techniques, and implementation of nightmare therapy for psychotherapy clients with posttraumatic stress disorder. Case examples of combat veteran trauma survivors are included. Approaches discussed include dream group, storyline alteration, story title conversion, sandplay, and face and conquer techniques. Based on a posttreatment survey administered to 25 clients, 65% of Ss reported the elimination of nightmares while the remaining 35% reported diminished distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)