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ABSTRACT

Towards a Unified Theory of Idiopathic Nightmares: Implications from Recent Experimental Research

 Ross Levin, Ph.D.
Associate Professor of Psychology
Ferkauf Graduate School of Psychology

Author of over two dozen articles on various dimensions of dreaming. Current interests include understanding the etiology of nightmares (and particularly their relationship to waking psychopathology), the relation of waking to dreaming cognition, and dreaming as a dissociated state of consciousness.

4) Recent experimental research on both the correlates of idiopathic nightmare production as well as their relation to waking psychopathology and emotional well-being will be extensively reviewed with the aim of providing an updated unified theory of this phenomenon from a clinical perspective within a cognitive science paradigm.

5) Attendees will be provided with a comprehensive overview of:
A) existing theories of nightmare production (why do they happen?)
B) the current experimental literature on nightmares (to whom do they happen?)
C) differences between idiopathic nightmares and other parasomnias (i.e., PTSD recurrent nightmares, night terrors, etc.)

Towards a Unified Theory of Idiopathic Nightmares: Implications from Recent Experimental Research
Ross Levin, Ph.D.

Although idiopathic nightmares are the most common form of the parasomnias (APA, 1994; Nielsen & Zadra, 2000), little is known about their etiology, pathophysiology, and connection with waking psychological functioning. Given recent evidence implicating heightened limbic activation in REM sleep (Hobson, Stickhold, & Pace-Schott, 1998; Solms, 1997), the phase most associated with phenomenal dreaming in general and nightmares in particular, understanding these connections more closely could help to clarify the role of emotional processing in both dream formation and waking psychological dysfunction.

Idiopathic nightmares are dreams which awaken the individual from sleep and are marked by intensified feelings of terror in which the dreamer experiences a paralysis of body movement, a sense of imminent danger and loss of control. Although the thematic content of nightmares may involve the intensification of any waking unpleasant emotion, fear is most commonly reported (Zadra & Donderi, 1993). These dreams are differentiated from posttraumatic nightmares (Ross, Ball, Sullivan et al., 1989) in that the latter often have a repetitive pattern which replays, in approximating form, an actual traumatic event (Kramer & Kinney, 1988). Indeed, clinical experience and preliminary research suggests that idiopathic nightmares and repetitive traumatic nightmares may be discrete disorders of dreaming, each with a distinct pathogenesis and clinical prognosis (Krakow, Kellner, Pathak, & Lambert, 1995; van der Kolk, Blitz, Burr, Sherry, & Hartmann, 1984). Although more work needs to be done to better understand the relationship between these parasomnias, the present discussion will be concerned with frequent, lifelong nightmares which occur independently of definable environmental triggers.
After almost a half century of neglect, the past 20 years has witnessed a proliferation of experimental research on the correlates of nightmares. Given their highly negatively-arousing quality and their often disruptive effect in the waking state, much of this work has investigated whether frequent nightmares are associated with heightened waking psychopathology (Hartmann, 1984; Hartmann et al., 1987; Kales et al., 1980; Levin, 1994, 1998; Levin & Raulin, 1991; Zadra & Donderi, 2000). This work has had a significant impact on shifting conceptions of nightmare etiology, with early psychodynamic theories (Jones, 1931) increasingly giving way to explanatory frameworks informed by personality theory (Hartmann, 1984), neurophysiology, cognitive processing models, and even evolutionary psychology (Revonsuo, in press). In this way, nightmares are increasingly seen as intensified states of emotional arousal and dysregulation which carryover from waking into the dream state.

This talk will present an overview of the experimental literature on the clinical correlates of frequent nightmare production with an emphasis on psychopathological covariants as well as normative cognitive style markers (fantasy proneness, imagistic immersion, absorption, suggestibility) which have been shown to facilitate nightmare production. A brief discussion of predominant current models of nightmare etiology will follow. Next, I will attempt to reconcile these findings into a unified causal model of nightmare production incorporating concepts from experimental psychopathology (diathesis-stress) as well as cognitive science (e.g., hyperactivated memory schemas) and the dissociation literature. Ideas for future research will conclude this discussion.

References

American Psychiatric Association (1994). Diagnosis and statistical manual of mental disorders (4th Edition). Washington, D.C.: Author.
Hartmann, E. (1984). The nightmare: The psychology and biology of terrifying dreams. NY: Basic Books.
Hartmann, E., Russ, D., Oldfield, M., Sivan, I., & Cooper, S. (1987). Who has nightmares? The personality of the lifelong nightmare sufferer. Archives of General Psychiatry, 44, 49-56.
Hobson, J., Strickhold, R., & Pace-Schott, E. (1998). The neuropsychology of REM dreaming. NeuroReport, 9, R1-R14.
Jones, E. (1931). On the nightmare. NY: Liverwright Pub. Co.
Kales, A., Soldatos, C., Caldwell, A., Charney, D., Kales, J., Markel, D., & Cadieux, R. (1980). Nightmares: Clinical characteristics and personality patterns. American Journal of Psychiatry, 137, 1197-1202.
Krakow, B., Kellner, R., Pathak, D., & Lambert, L. (1995). Imagery rehearsal treatment of chronic nightmares. Behavior Research and Therapy, 33, 837-843.
Kramer, M., & Kinney, L. (1988). Sleep patterns in trauma victims with disturbed dreaming. Psychiatric Journal of the University of Ottawa, 13, 12-16.
Levin, R. (1994). Sleep and dreaming characteristics of frequent nightmare subjects in a university population. Dreaming, 4, 127- 137.
Levin, R. (1998). Nightmares and schizotypy. Psychiatry, 61, 206- 216.
Levin, R., & Raulin, M. (1991). Preliminary evidence for the proposed relationship between frequent nightmares and schizotypal symptomatology. Journal of Personality Disorders, 5, 8-14.
Nielsen, T., & Zadra, A. (2000). Dreaming disorders. Revonsuo, A. (In press). The reinterpretation of dreams: An evolutionary hypothesis of the function of dreaming. Behavioral and Brain Sciences, 23.
Ross, R., Ball, W., Sullivan, K., & Caroff, S. (1989). Sleep disturbance as the hallmark of posttraumatic stress disorder. American Journal of Psychiatry, 146, 697-707.
Solms, M. (1997). The neuropsychology of dreams: A clinico- anatomical study. Mahwah, NJ: Lawrence Erlbaum.
van der Kolk, B., Blitz, R., Burr, W., Sherry, S., & Hartmann, E. (1984). Nightmares and trauma: A comparison of nightmares after combat with lifelong nightmares in veterans. American Journal of
Psychiatry, 141, 187-190.
Zadra, A., & Donderi, D. (1993). Variety and intensity of emotions in bad dreams and nightmares. Canadian Psychologist, 34(2a), 294.
Zadra, A., & Donderi, D. (2000). Nightmares and bad dreams: Their prevalence and relationship to well-being. Journal of Abnormal Psychology, 109, 273-281.