// Nightmares

Question 1

Definition and prevalence

Answer 1

Very disturbing dreams, involving any unpleasant emotion, vividly recalled

1 or 2 per year

10-25% have more than 1 per month

Question 2

Common contents of nightmares

Answer 2

Robert 2014

• Physical aggression (interpersonal conflict in bad dreams)
• Unfortunate endings
• More emotionally intense than bad dreams
• Only 35% contain primary emotions other than fear compared to 55% of bad dreams

Question 3

PTSD nightmares

Answer 3

• Different from idiopathic nightmares bc they tend to be repetitive, have content from waking life, occur earlier in the night, can have body movements

Question 4

Theories

Answer 4

Neurocognitive model

AND model

Evolutionary theory

Image contextualisation

Question 5

Neurocognitive model

Answer 5

Nielsen & Levin 2007

• stressful and negative emotional events produce affect load
• affect load triggers acquired (conditioned) fear memories
• nightmares are failed dreams

Question 6

AND model

Answer 6

Nightmares function to extinguished conditioned fear memories by creating new fear extinction memories

1. element activation - dissociate memory from real-world context
2. element recombination - pair conditioned stimulus with new non-fearful context (hippocampus)
3. emotional expression - change emotional reaction to recombined features (amygdala)

Evidence:

• Recurrent dreams are usually emotionally negative
• people who used to have recurrent dreams have higher emotional well-being - caused by extinction of conditioned response

Question 7

Evolutionary theory

Answer 7

Revonsuo 2000

• nightmares are adaptive threat simulations - rehearsals of threat perception and avoidance

Question 8

Image contextualisation

Answer 8

Hartmann

• all dreams have an emotionally-based Central Image which contextualises and connects emotions and memories
• If the Central Image is negative enough, it can produce nightmares

Question 9

Factors affecting nightmare frequency

Answer 9

Thin-boundariness

Acute stress

Well-being

Impaired executive function

Affect distress

Question 10

Thin-boundariness

Answer 10

Hartmann 1991

• People with thin boundaries are more sensitive to emotional stimuli
• react more negatively to nightmares and recall more of them

Question 11

Acute stress

Answer 11

Wood 1992

• San Francisco earthquake caused 2x more nightmares in SF students than Arizona students
• 40% of SF students’ nightmares were about earthquakes, 5% Arizona students’
• Earthquake nightmares not more emotionally intense than other nightmares

Question 12

Well-being

Answer 12

Belicki 1992

• more related to nightmare distress than frequency

Balgrove 2004

• poor well-being = higher unpleasant dream frequency and nightmare distress

Zadra 2000

• poor well-being = higher nightmare frequency but not unpleasat dream frequency

Question 13

Impaired executive function

Answer 13

Simor 2012

• impaired prefrontal and fronto-limbic functioning during REM causes disturbed dreams
• nightmare sufferers have poorer emotional stroop and verbal fluency task performance but not for colour stroop tasks
  
  • suggests impairment of executive function involving semantic info

Question 14

Affect distress

Answer 14

People with higher affect distress (trait sensitivity to affect load) have higher nightmare frequency

• experiencing distress in response to affect load causes dreams to become nightmares

Question 15

Treatment of nightmares

Answer 15

Neidhardt 1992

rehearsal group

• record nightmares for a month
• once a day for 3 days:
  
  • select one and write it down
  • change what you want
  • write what you changed
  • rehearse with imagery
• 72% nightmare reduction at 3 months

Recording group

• record nightmares for a month
• 47% reduction at 3 months

both significant but not significantly different