Thursday, March 13, 2014

Lexicon of Madness -- Nightmare

Nightmare, Henry Fuseli (1781)

Nightmare: A long, frightening dream that wakes a person from sleep. (If there is no awakening, then it is simply a "bad dream.") The frightened feeling is maintained after awakening, often to the point where the person is afraid to go back to sleep. The nightmare images and feelings might haunt the person for days or even years afterward. Common nightmares themes include being chased, falling, and the death or injury of loved ones (or self). In addition to fear, emotions such as anger, guilt, sadness, disgust, or frustration might be evoked by the nightmare. Traumatic nightmares are dreams of events that have actually occurred in the dreamer's life. There might be some alterations of details, but traumatic nightmares tend to vividly recapitulate the original trauma. Repetitive traumatic nightmares are a hallmark of Posttraumatic Stress Disorder (PTSD). Not all persons with PTSD are awakened by their dreams about the traumatic event, but bed partners will often report that the person talks, screams, or thrashes wildly in his sleep. The insomnia observed in many patients with PTSD is often stems from an attempt to avoid trauma-related nightmares. An effective treatment is to write out in detail as much of the dream as can be remembered. During the day, read the dream account to yourself several times, taking care to calm yourself with focused breathing or visualization after each reading. Before going to bed, engage in a relaxation ritual (bath, reading, etc.) because the more relaxed you are when you go to bed, the less likely it will be that you will have a nightmare that night. On the next day, re-write your dream account, changing a couple of key details (but not giving the dream a "happy ending"). Rehearse the revised dream account several times (calming yourself as needed), and go to bed that night in a relaxed state. It is possible that this procedure is effective because it makes clear the distinction between the traumatic dream and the trauma itself.

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