A major symptom of Complex PTSD / PTSD is nightmares. I myself have suffered from these and they have led to frequent waking during the night, sheets and pillowcases damp with sweat, thrashing around in my sleep to the extent that I have, on several occasions, knocked the lamp (and several other items, such as piles of books, the alarm clock, cups of cold, unfinished tea etc) off my bedside table with arms wildly flailing about like those of a crazed and demented windmill and, even, falling out of bed a few times. I have also woken myself up shouting and, even, screaming, more than once.
A particular torment of nightmares is, of course, that after a day spent in mental anguish in a state of wakefulness, they prevent one from escaping this mental pain even in sleep so there is no respite from one’s suffering. Indeed, when one has intense and terrible nightmares, one fears going to sleep; for us, it is not a time of mental recuperation, but of continued psychological torture. This can be so devastating to the morale that one may fear one will go permanently and irrevocably insane.
According to the Harvard psychologist, Dr D Barrett, an expert on dreaming and dream analysis, PTSD nightmares tend to contain the following types of themes/symbols:
The Themes And Symbols Of PTSD Nightmares
– being chased
– being in danger
– being punished
– being isolated
– being powerless
– being trapped
– physical injury
Nightmares, Suppression, Repression And Dissociation :
If we have extremely painful memories relating to our traumatic childhood then we may, as a means of psychological self-protection, cut off from them mentally.
In order to achieve this we may suppress the memories (i.e. try to put them to ‘the back of our minds’). This takes conscious effort and can be counterproductive – see The Rebound Effect below).
Alternatively, we may repress the memories; this is an automatic/unconscious process that stores the memories away so deeply in the mind that they become inaccessible to conscious awareness. Mentally cutting ourselves off from painful memories in such a manner is known as dissociation.
Nightmares And An Overactive Amygdala:
A study conducted by McNamara suggests that many individuals who suffer from nightmares have an overactive amygdala (the part of the brain associated with fear and threat perception) and, indeed, studies show that chronic and severe trauma can interfere with the amygdala’s functioning. McNamara also suggests that sufferers of nightmares often have a dysfunctional prefrontal cortex resulting in impaired ability to control mental images – again, it is known that protracted, serious trauma can damage the brain’s prefrontal cortex.
Processing Of Traumatic Memories
However, because these memories are dissociated, they remain unprocessed by the brain and a leading theory as to why dreams/nightmares occur is that they represent the brain’s attempt to process the dissociated memories.
Barrett’s research has led her to the view that immediately following traumatic events, a person’s nightmares about them tend to quite closely reflect what actually occurred. However, as the traumatic events that triggered the nightmares recede further and further into the past, the PTSD nightmares relating to them become increasingly symbolic.
What Can We Do To Alleviate Nightmares?
If our nightmares do not result in the effective processing of our traumatic memories they can become ‘stuck’; this can lead to recurring nightmares that tend to centre upon the same themes.
To alleviate such nightmares, it is necessary to attempt to process the traumatic memories in our waking lives (assuming they have been suppressed rather than repressed – see above).
We can attempt to process the material contained within our nightmares in the following ways :
– by keeping a written record of the nightmares (e.g. by recording our recollections of them or writing these down using a pen and pencil kept by the bed etc)
– by describing our nightmares to another person (who is emotionally supportive, such as a therapist) and trying to work out what their themes and images may represent.
– going through the nightmare in our minds when awake but changing its ending to a positive one – then mentally replaying/rehearsing this new, positive ending. It is then helpful to write out what happens in the nightmare, including writing out the new, positive ending. Alternatively, we could draw a series of pictures representing the nightmare, but, again, incorporating the new, positive ending.
– by imagining, when awake, carrying out a simple action in our dream, such as taking a single step, and saying to ourselves: ‘You are completely safe, this is just a dream’. If we then mentally rehearse this before we go to sleep we may find this action, carried out in our dream, will cue the comforting and reassuring thought (the action that is to act as the cue can be anything simple that is likely to recur in the nightmare).
Nightmares And The Rebound Effect
In relation to some of what has been said above, it is useful to look at a psychological phenomenon known as the rebound effect :
If we try very hard not to think about something, this, paradoxically, frequently increases the probability that we will think about it. The classic example that is given to first-year psychology undergraduates is the instruction NOT to think about a pink elephant for the next minute. Of course, this instruction is impossible to carry out (try it if you don’t believe me!).
This is known as the rebound effect and research suggests the phenomenon may apply to nightmares, too. One possible technique to reduce the probability of having a nightmare is, therefore, to actually think about whatever it is the nightmare represents (if this has been inferred from reflection/dream analysis) for a few minutes before going to sleep as trying not to do so, because of the rebound effect, may actually increase the chances that the nightmare will occur, however counterintuitive this may sound.
Horowitz’s Information Processing Theory, Flashbacks And Nightmares
According to the psychological researcher Horowitz, some symptoms of posttraumatic stress disorder (PTSD) can be understood more clearly with reference to what he termed Information Processing Theory.
What Is Information Processing Theory And How Does It Relate To Post Traumatic Stress Disorder?
Horowitz suggests that if we undergo a very traumatic experience, such as significant and chronic childhood trauma, we develop a powerful unconscious drive to ‘make sense of it’, ‘work through it’ and mentally process it.
In relation to this, Horowitz proposes that we all have an internal mental model of how the world works (mental models are sometimes referred to by psychologists as schemas).
However, when we undergo severe trauma, the experience does not ‘fit’ this internal mental model or schema. This causes us stress and we are unconsciously driven to reconstruct our mental model/schema so that the traumatic experience CAN be fitted into it (i.e. mentally integrated).
This process is complex and takes time, especially if the traumatic experience was severe and long-lasting.
Horowitz states that this processing of the traumatic event involves repeatedly, mentally replaying it; this can lead to :
- intrusive memories
The intensity and frequency of these intrusive memories, nightmares and flashbacks can attain a critical point at which they are so distressing, mentally overwhelming and emotionally exhausting that, to avoid them, we become psychologically numb.
Horowitz suggests that the processing of the traumatic experience can involve vacillating between these two states until a final state of mental equilibrium is reached at which point the trauma has been successfully processed.
Problems arise, of course, if we become ‘stuck’ in the ‘vacillation phase’ and, in such a situation, professional therapy may be considered. Research suggests that two effective therapies are dialectical behavioural therapy and mindfulness meditation
Overcoming Nightmares And Hallucinations With ‘Paradoxical Intention.’
Nightmares, Hallucinations And Trauma-Based Memories :
When nightmares and hallucinations are linked to psychiatric disorders such as complex PTSD and BPD which, in turn, are linked to childhood trauma, it is quite possible that the content of those nightmares and/or hallucinations are founded, at least in part, upon TRAUMA – BASED MEMORIES.
Paradoxical Intention :
Of course, the content of nightmares and hallucinations is frequently highly disturbing and distressing – I have had nightmares of such violence that they have, on more than one occasion, caused me to fall out of bed. Frequently, too, I have thrashed about so vigorously in my sleep that I have knocked lamps, clocks, overflowing ashtrays, radios and half-finished cups of tea off my bedside table (although never all at once, albeit small consolation) – however, one possible way to reduce their intensity, or, even, overcome them may, counter-intuitively, according to psychodynamic theory, be facilitated by a process known as PARADOXICAL INTENTION.
Paradoxical intention is a concept first described by Dr Viktor Frankl, the famous psychiatrist and concentration camp survivor who founded Logotherapy, based on the idea that psychological symptoms can be made worse by trying too hard to fight them, summed up by the pithy maxim, ‘What you resist persists.’
So, applying the idea of paradoxical intention to the treatment of nightmares and hallucinations involves a trained psychotherapist encouraging the client to view his/her nightmares and /or hallucinations from a completely different perspective, i.e. rather than seeing the hallucinations/nightmares as something purely destructive and to be feared, the client is encouraged, instead, to try to see these phenomena as helpful clues (no matter how bizarre and nonsensical they may appear to be on the surface) which can be analyzed and interpreted for salient meanings (whether literal or symbolic), thus helping to expose, and shed light upon, possible trauma-based memories that underpin the individual’s psychiatric condition.
In this way, the client can be both empowered, and, under the care of an appropriately trained psychotherapist, can also be sensitively and compassionately helped to understand, where appropriate, the deep roots of his/her particular psychological difficulties, which may prove to be an effective first step towards ameliorating them.
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David Hosier BSc Hons; MSc; PGDE(FAHE).