Dream Theatre

The treatments are controversial. Some therapists take issue with changing nightmares content,arguing that dreams send crucial messages to the waking mind. Nightmares are important because they bring up issues in bold print, said Jane White-Lewis,a psychologist who has taught about dreams at the Carl Jung Institute in New York.
Nightmares have fascinated people for centuries,their meaning debated by analysts of all schools of thought,their effects so powerful that one terrifying nightmare can affect a person for a lifetime. From 4 to 8 per cent of adults report experiencing nightmares,perhaps as often as once per week or more,according to sleep researchers. But the rate is as high as 90 per cent among groups like combat veterans and rape victims,Dr Krakow said. He and other clinicians are increasingly using IRT to treat troops in the Iraq and Afghanistan wars.

Deirdre Barrett,a psychologist at Harvard Medical School who is an expert on dream incubation,inducing dreams to resolve conflicts,and on the connection between trauma and dreams said she was struck by the growing interest in nightmares as a result of war trauma and torture. Now therapists are getting the message that you can influence dreams,ask dreams about particular issues and change nightmares, she said. Hollywood has just produced its own spin on the idea of controlling dreams,with the release earlier this month of Inception,a thriller whose plot swirls through the darkest layers of the dream world. Underlying the story is the concept of lucid dreaming,another technique used by clinicians to help patients afraid of their dreams understand that they are dreaming while a dream is in progress.

Dr Krakows nightmare therapy typically includes four sessions of group treatment and between one and ten individual sessions,though Dr Krakow said between three and five sessions are usually effective. Patients participate in sleep studies as needed,and do considerable work on their own,using a manual he published to guide them,Turning Nightmares Into Dreams.

His latest research found a striking connection between PTSD and a variety of sleep disorders. In an analysis of the sleep studies conducted on more than a thousand patients with varying degrees of post-traumatic stress,he found that 5 to 10 other sleep problems may be involved. High rates of sleep apnoea,for example,were found even in patients with moderate symptoms of post-traumatic stress.

Dr Krakow conducted his first major research between 1995 and 1999,looking at the effect of imagery rehearsal on 168 sexual assault survivors who suffered from nightmares.
The results of a randomised controlled trial were published in a 2001 paper in the Journal of the American Medical Association. Of the subjects,95 per cent had moderate to severe PTSD,97 per cent had experienced rape or other sexual assault,77 per cent reported life-threatening sexual assault and 58 per cent reported repeated exposure to sexual abuse in childhood.

The treatment group,88 women,participated in three sessions of imagery rehearsal therapy,while the control group,80 women,was on a waiting list and continued with whatever treatment they had been undergoing. Of the 114 that completed follow-up at three or at three and six months,those in the treatment group had significantly reduced the nights per week with nightmares and the number of nightmares per week,the paper said. The control group showed small,nonsignificant improvement on the same measures. And symptoms of post-traumatic stress decreased in 65 per cent of the treatment group,while they either remained unchanged or worsened in the control group.

Roberta Barker,55,was a participant. She was kidnapped in Japan,where she had gone to teach English,and was raped for three days before escaping. Her nightmares,replaying the horror,were so frightening she could barely sleep. Medications did not seem to work. She was on the verge of suicide.I drank enough coffee to float a battleship, she said in a recent visit to Dr Krakows clinic. A few times a week I was reliving the entire set of days in one night.
When Dr Krakow told her that nightmares can be a learned behaviour and that she had the power to stop what had become a habit,she was sceptical. He explained she could come up with another dream and practise it and that it was possible for her to no longer have the nightmares of the torture.

Some patients work to change the plot of their dreams; a rape victim who was receiving treatment with Barker decided to script a dream about confronting her rapist with a baseball bat. But Barker said she felt she had to come up with an entirely new dream. So she chose birds.
Ive always loved birds, she said. I had fed birds,the images were solid,I could hear them flying and talking. Now,instead of waking up screaming,I wake up knowing Ive dreamed of birds.
NYT