Learning to Fight Chronic Nightmares

Is there a scientific difference between a bad dream and a nightmare?

May 29, 2008 — -- Everyone has nightmares -- everyone, that is, except Ross Levin.

"I actually have very few nightmares," he said.

Maybe that's because Levin is a psychologist who spends most of his time studying terrifying dreams. He says he's figured out what seems to be a shockingly simple method for fighting chronic nightmares, the kind that haunt Rachel Smalls.

"A typical nightmare for me probably goes through a number of different themes," said the college student who lives in Boston. "There's the natural disasters, tornadoes, there's the apocalyptic dreams."

Smalls kept a journal of her nightmares and wrote about one set in a hotel lobby.

"I walk towards the hotel desk. I see my parents at the elevator very worried. I say I forget the room number and my mom is worried and she can't remember it either, but doesn't say so. She says, yeah, there's no one at the desk, but I knew that meant something terribly evil was going on."

"Then one face of the hotel crumbles away and there is a terrible series of demonic noises like a construction site and synthesizers and sound, kind of like a dragon. I can see a huge demon, very typical, the kind you would see in a movie or comic book -- muscular torso, red skin, rising from flames. And at the end of the hotel is Satan himself. He is a normal man, I don't know, who has this awful goat mask on. It has really, really long horns like an antelope …"

Bad Dreams vs. Nightmares

It turns out there's a scientific difference between a bad dream and a nightmare.

"Bad dreams would be bad dreams we remember in the morning and say, I had a bad dream last night," said Levin. "Nightmares are dreams that jackknife you up in the middle of the night in a sweat."

Bad dreams -- as opposed to nightmares -- are how our brains teach us to deal with stress and fear.

"We think that dreams are emotion regulators; they're emotion thermostats," said Levin. "When stress gets too high, we begin to have bad dreams and nightmares. And so in that sense they serve as a signal to say whoa, stress is at a dangerously high level. And so that feeds back to the brain to try to reduce the stress, or if we pay attention to it during waking, we would be well-off to spend the tension to try to regulate our stress during waking."

Levin says bad dreams can serve a beneficial purpose, but nightmares like those Smalls suffers are a sign of an overload of stress.

"Her dreams are filled with images of gore and violence and threat and fragmentation and body parts and people hanging and things of that nature," Levin explained. "A lot of running away. A lot of panicking. And one of the things we found with Rachel that I think is the most striking is, we had her keep track of her daily mood and her daily stress and her daily coping with stress for about two weeks. And a pattern clearly emerged in her paperwork. Her negative emotions way outweighed her positive emotions each day."

Levin said those negative emotions "reached crescendos" the nights she had nightmares, particularly emotions related to "a lot of interpersonal difficulties. A lot of troubles with loved ones which are particularly salient triggers for nightmares."

Rewriting Your Nightmares

According to Levin, many patients he treats for nightmares also suffer from other psychological or psychiatric issues.

"I would say that a good third of my patients that I see in my clinical practice are people who I treat for post-traumatic stress disorders, anxiety disorder that I treat via the nightmares," he said. "Because once you reduce the nightmares you've actually dampened the whole system down."

Levin's nightmare-fighting method involves replaying your nightmares by day, and then changing the script.

"This works best when people have the same nightmare over and over again. They script the nightmare and then they change the ending of the nightmare into something more benign," he said. "And then they rehearse this scripted nightmare during the day -- the more the better. And then they do it before they go to bed."

This rehearsing is done through what Levin calls "imaginal exposure."

"They close their eyes and they imagine the dream happening and they walk themselves through it in the script. And they imagine it with the new ending. And they do this over and over again."

The method may sound too good to be true, but Levin said "that's the beauty of it."

Diffusing Dreams

Something like this seems to have worked for Josh Summers, who had recurring nightmares while breaking up with a girlfriend.

"There was some infidelity. There was some betrayal, some dishonesty and feelings of rejection and jealousy and all that," he said. "I don't want to be an angry person, a spiteful person, a bitter person, a jealous person and I just prefer to push those things away and suppress them in a way. And you can only do that so long."

Hence a string of recurring nightmares that went something like this:

"I opened the door to reveal a demonic creature that was throwing fireballs about the attic. The beastie took a momentary notice of me and then proceeded to carry on with throwing fireballs about the attic. Looking around, I realized the situation was more dire; the beastie was throwing fireballs at the family's invaluable art collection stored in the attic. Original Rembrandts and Velazquezes were going up in flames, and I needed to get over my fear in a hurry and deal."

But he had his last nightmare when, while still asleep, he changed the script.

"For whatever reason, a song started going through my head. And I began humming the melody, and as I hummed, the beastie began to settle down, or at least pause from its mission. When I got close enough, I bent down, picked up the beastie and held it like an infant in my arms. And I thought, in the dream, 'This is really weird.'"

Levin was impressed with how Summers was able to "diffuse that dream."

"This was very clever. He did this all while he was asleep. There's no final gory or violent outcome of this outcome so he never gets hit by the fireball. … The brain knows how to do that if we don't get in the way of it."

As for Smalls, Levin says her nightmares may be more difficult to "rescript" without professional help, but adds that this technique can be helpful to anyone who experiences nightmares.

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