Contrary to what some might think, disturbing dreams are more common than the sweet ones we wish upon ourselves before we fall asleep. However, most people don’t remember much of their bad dreams as they sleep through them. A good night’s rest is essential for brain health and mental well-being. We sleep about three-quarters of our lives. Sleep deprivation is associated with heart disease, obesity, inflammation, depression, and worsening anxiety.
About 4 to 6 percent of Americans have nightmare disorder. This is also known as a dream anxiety disorder. It is a sleep disorder characterized by frequent, vivid nightmares. How often? According to Michael Nadorff (Ph.D.), the frequency is at least once per week. His research focuses on sleep problems, especially nightmares, and their relationship with suicidal behavior. This disorder is defined as vivid, long-lasting, vivid dreams that wake the person up and cause significant distress, emotional dysregulation, and daytime impairment.
ADAA was informed by the Associate Professor and Director at Mississippi State University of the Clinical Psychology Ph.D. program about his fascination with nightmares and their effects on mental health. He also spoke out to explain how he came up with enlightening evidence-based advice.
Dr. Nadorff will present this information and his research and treatment strategies at ADAA 2023 Annual Conference, DC, in a State of Art Clinician Session titled Nightmares – Causes, Correlates, and Treatments. Dr. Nadorff talked to ADAM about his work and why he wanted to present his session.
Treatment Is Not a Pipe Dream
Dr. Nadorff stated, “Nightmares can be an interesting thing, but we don’t talk as much about alleviating them,” noting that nightmare sufferers often hesitate to disclose their distress to healthcare professionals.
“Some people believe it’s normal for them to have so many nightmares. They don’t know their treatment.” He said that not many doctors are trained to treat nightmares. However, he hopes that this will change.
Dr. Nadorff believes that treating nightmares is easy. “If I spend an hour with a physician, that clinician can treat nightmares.”
His bold statement is supported by scientific research and evidence-based practice. He said cognitive strategies involving modified Cognitive Behavioral Therapy (CBT), relaxation, imagination, and practice of new scenarios are easy and enjoyable.
Imagery Rehearsal Therapy (IRT), which I use for nightmares, is a therapy that helps people change their nightmares in any way that makes them less distressing, frightening, or traumatic.
Dr. Nadorff shared how he prepares the new dream with patients and has them practice it twice daily for approximately 10 minutes each using visual imagery. He also instructed that they work through the new dream in their sleep hours as detailed as possible.
“Usually, one of two things usually happens when you do that. He said, “Either you stop having nightmares or start dreaming new dreams.”
Reimagine all the People…
Dr. Nadorff spoke of the impact therapy had on a veteran that he met during his clinical training. A patient was experiencing a constant terror-filled nightmare. He feared that something terrible would happen to the military vehicle he was driving, which was full of soldiers. He would then wake up shaking, sweating, and feeling shaken.
Dr. Nadorff collaborated with him to reimagine the dream.
He wanted his own car, and not a military vehicle. He drove his children and their parents to the park instead of with soldiers. Dr. Nadorff explained that his father had died before his children were born. He regretted not having met his grandfather so he was also in the car. The patient was able to visualize the new dream and went home to put it into practice.
Dr. Nadorff said, “The next session, he’s in his waiting room, crying,” thinking that he had done something wrong because the patient seemed so upset. The patient then tells Dr. Nadorff, after he has returned to the office, that he had a new dream.
“He said that it was a meaningful experience to share the dream with his father and his children,” Dr. Nadorff stated, “it was so humble to see that, and to see him overcome his nightmare and put in its place, something so important happened.”
Meaningful and possibly life-saving
Nightmares can be frightening. Those with nightmare disorder may experience persistent, severe feelings of anxiety, sadness, guilt, rage, and panic. It is possible to experience strong emotions such as those described above on a regular basis, which can cause problems with daily functioning and even lead to mental health issues. Dr. Nadorff states that many people suffering from nightmare disorder are affected by a mental condition such as PTSD or borderline personality disorder, and even schizophrenia.
“Nightmares may be a sign of schizophrenia relapse, and there is some relationship between nightmare disorder and depression.
Dr. Nadorff states that nightmare disorder can worsen a mental condition and lead to serious consequences if it is not treated.
He said that the more severe nightmares someone experiences, the more likely they are to commit suicide. This was what triggered his suicide research. He became interested in sleep disorders and treatments.
There are many treatments for nightmare disorders, including medications, but Dr. Nadorff believes that his imagery therapy treatment is the most effective, scientifically based, and the fastest.
Dr. Nadorff stated that the 2023 ADAA conference would be a great way to share information and get health professionals interested in becoming trained. He expressed hope that his session would be meaningful. “You can have the most effective treatment in the world but if it isn’t used or accessible to the people who need it, it doesn’t matter.”
