Persistent nightmares can be reduced by a combination of positive storytelling and memory manipulation during sleep.
For some unfortunate people, every night is Hallowe’en.
Nightmare disorder, as the name suggests, is nightmares of enough frequency and intensity to cause significant distress or impairment of social or occupational functioning. About 4% of people have at least one nightmare a week.
Imagery rehearsal therapy (IRT) is the recommended treatment: a type of cognitive behavioural therapy in which dreamers recall their nightmare but change the story into one with a positive ending, then rehearse the rewritten story during the day.
The authors of a new (nicely timed) paper in Current Biology wondered whether adding targeted memory reactivation (TMR), the manipulation of memory processing via cues given during sleep, would help the 30% or so for whom IRT is ineffective.
Everything is better when you add TMR!
They took a group of 36 nightmare sufferers and gave them all IRT sessions. Half of them were also played a sound during the IRT. All of them went about their business wearing actimeters that measured REM sleep, and played the cue sound during REM.
The TMR group had significantly lower frequency of nightmares post-intervention and at three-month followup, and they also reported increased joy in dreams.
One hypothesis around persistent nightmares is “dysfunctional fear extinction”: dreams are supposed to condition the fear response out of you by playing threatening stimuli in a novel, out-of-context way (yep, that sounds not fear-inducing at all), and in nightmare disorder this doesn’t work.
The authors propose that the IRT component of the combined therapy may help inhibit fear in dreams through fear extinction, while the TMR boosts emotionally positive dreams through the sound conditioning.
“Interestingly, IRT with TMR during REM sleep in our protocol decreased the frequency of nightmares and increased positive emotions in dreams, but did not further decrease fear in dreams compared to controls with IRT only. This may indicate that positive dreams progressively took over nightmares as the most prevalent type of dreams in the patients of the TMR group.”
Some people may be beyond the reach of even this improved therapy. The other night your Back Page correspondent had a nightmare about interviewing a much admired personage with only silly questions to ask, a recorder that wasn’t working, a sudden inability to write words and an environment of constant interruptions – and we cannot think of a single happy ending to that story.
If something makes you wake up screaming, send your dream journal to penny@medicalrepublic.com.au.
