Rewriting Your Nightmares

nightmare sceneA scene right out of a nightmare. (George Ruhe for The New York Times)

Halloween is filled with the stuff of nightmares — costumed ghosts, vampires and slasher-movie monsters. But for some people, nightmares aren’t holiday fun. As many as 25 percent of adults have at least one nightmare a month. For a troubled 7 to 8 percent of the population, nightmares interrupt sleep at least once a week.

But many people don’t realize that having chronic nightmares is a medical problem that can be treated.

A nightmare is a complex dream that can cause high levels of anxiety and terror. Nightmares typically interrupt sleep as the mind plays out frightening scenes that involve imminent harm, like being chased, threatened or injured. For people who suffer from post-traumatic stress, nightmares tend to involve reliving the original horror of the traumatic event.

It’s believed that nightmares occur when the brain is struggling to process stress or severe trauma. But for some people, the bad dreams essentially become a learned behavior, and the brain gets stuck in a pattern of troubling nightmares.

In the past, therapists have encouraged patients to talk about their nightmares in hopes of resolving the underlying issues that cause them. But more recently, therapists have adopted “imagery rehearsal therapy,” a pioneering technique developed by Dr. Barry Krakow at the University of New Mexico School of Medicine.

Instead of focusing on the bad dream, imagery therapy looks for ways to rewrite a nightmare’s script. The concern is that talking too much about a troubling dream may serve to reinforce it. Imagery rehearsal therapy allows the dreamer to rewrite the nightmare during the day. After practicing basic imagery techniques — imagining yourself on a beach or eating a hamburger, for example — the troubled dreamer chooses a better version of the dream, explains Shelby Harris, clinical psychologist at the Sleep-Wake Disorders Center at Montefiore Hospital in New York.

“We mention the nightmare once and forget about it,” Dr. Harris said. “I tell patients to change it anyway they wish. You can change a tiny bit of it, or change the whole thing.”

The key is to “practice” the new version of the dream by imagining it a few times during the day. While the method is highly successful, helping about 70 percent of people who try it, it can work differently in different people. Some develop the ability to change the nightmare while they are having it. One patient of Dr. Harris was troubled by a dream in which she was attacked by sharks. During imagery therapy, the patient chose to change the sharks into dolphins. When she started to have the nightmare during her sleep, the sharks also changed into dolphins.

Other sufferers notice that after therapy the nightmares disappear and the general quality of all their dreams starts to turn more positive. The therapy treatment is typically brief, lasting only two or three sessions. Children can also be taught the technique.

“Practicing imagery during the day and changing imagery can really affect your imagery at night,” Dr. Harris said.

Dr. Harris said people suffering from occasional nightmares can try rewriting the script of their nightmares on their own. But people who are waking often from nightmares or who are developing insomnia or a fear of sleeping should seek professional help before the problem becomes severe.

“If you’re having a nightmare at night, you’re waking up, which makes you tired during the day, and you’re thinking about it,” Dr. Harris said. “Because it’s distressing, that causes more stress, which can cause more nightmares at night. It’s a cycle many people can’t break.”

To learn more, visit Dr. Krakow’s Nightmare Treatment Center Web page and take the nightmare quiz to help determine your risk for a nightmare disorder. And read my colleague Natalie Angier’s recent Basics column on nightmares.

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Running from Zombies October 31, 2008 · 12:33 pm

From my childhood on I had at least 2 a year or more what I called ” Night of the living dead” nightmare. I kid you not! I Each time the dreams were more and more frightening,I’d get bit, or even killed in these nightmares. But in each dream I was constantly trying to figure out how to escape and made plans although they failed each dream.

Last year I had a dream where I actaully formed a plan that worked and beat the Zombies, I have not had that dream ever again. My frequency of nightmares have decreased as I’ve decreased my stress levels. No doubt I really wasn’t running from brain eating zombies but something else consuming my life which I vanquished..

FROM TPP — So interesting. I’ve always had a bit of a nightmare problem. As a kid I had an aliens attacking the school dream that started up at the end of every summer just before school started. It was ridiculous in the retelling, which could never capture how scary it really was. Obviously I had some pre-school anxiety. It stopped around my junior year in high school, a time where I had found my place, a school sport and was generally a happy teen. I haven’t thought about that dream in years.

I don’t have nightmares much, but when I do the usual course is that I will wake from the dream in a state of high agitation. I have always had the habit of imagining the next scenes of the bad dream, where I take control or where it otherwise turns out OK. I guess this amounts to the same strategy as discussed here.

Rob L, N Myrtle Beach SC October 31, 2008 · 1:29 pm

The approach to dealing with nightmares described in this Well blog entry are part of the constructivist branch of psychotherapy. It has been around for about 35 years now. Some of its practitioners speak about “rewriting the script” of one’s life as though it is an alterable screenplay. This link talks about the constructivist philosophy and gives a few more links:

//www.goodtherapy.org/Constructivisim.html

My own opinion is that some aspects of life are “re-writable”, but the stage foundation, its location, the proscenium arch and much of the set are not elements which are alterable via talk therapy.

What these therapists talk about doing with rescripting one’s life is comparable to where you stand, walk and sit on the stage, what lines you say, and whom you speak with and for how long. Such changes may make one feel better, or not but the broad outlines of one’s life will stay the same.

I believe acceptance and stoic resignation are a better alternative for those who have intractable health problems, or other difficult, refractory, personal problems. But talking with a paid consultant can certainly make a person feel better and help them develop coping strategies.

For many years, I suffered from terrifying nightmares about people who were trying to catch me and torture me for the pleasure of watching me suffer. Occasionally, even now, a news article about the Congo, will trigger something similar. But it was all really about my relationship with my mother who had enormous power to hurt me emotionally as a child (and who suffered pretty miserably during a war herself). A better understanding and lots of time to heal has made those nightmares rare — unless of course I read about something awful in the news. At least now I know where the vulnerabilty comes from so I can say– oh, that again — when I wake with my heart pounding.

David Chowes, New York City October 31, 2008 · 2:24 pm

Nightmares are a subset of dreaming. According to the literature, there are many theories concerning the meaning of dreams, their purpose… So, no professional REALLY KNOWS!

I take great delight in ‘horror movies.’ [My favorites are the 1956-original version of THE INVASION OF THE BODY SNATCHERS, (the original) NIGHT OF THE LIVING DEAD and Toman Polansky’s ROSEMARY’S BABY.]

Please note that the first two are in black and white and low budget which adds to the scary ambiance and enhances the ambiguity (and, saves money in production costs). The ambiguity makes YOU a far more active participant in the horror. The horror is mainly in YOUR HEAD — not just on the sreen

HALLOWEEN cards, costumes, costumes… makes for the second most costly holiday in our country (Chistmas is first). Any relationship?…

But, I hate HALLOWEEN — a product of our id impulses. It says many malevolent things about human nature. Where as films can be artful representations — HALLOWEEN represents our worst — impulses in the most vulgar manner. (You couldn’t pay me to go to the annual Village Parade.)

CHRISTMAS is a transcendent self; HALLOWEEN is reversed into the most decasent display of parts of all of us.

Nightmarish dreams can be treated (according to your comments). But, why do we dream? Benign or dreadfully scary?

Be careful tonight…!

I mention the above films

I had PTSD, along with chronic nightmares for years. I tried something similar to this method, but only for the nightmares – I don’t believe in “re-scripting” real life.

I had a great deal of success with “re-scripting” my nightmares. it took a long time but it was worth the wait – it’s over ten years since I’ve been jolted awake in a state of hyper-terror.

I did one of two things with each recurring nightmare, depending on the theme. If I was being attacked, I thought of a successful way to win the battle. Then I had to remember how to fight while I was asleep.

If I was being attacked by supernatural beings, I stood my ground and told them that they were not allowed to attack me on this plane: the planet Earth belonged to mortal beings, not to spirits. This worked the first time I tried it, but it is difficult to remember these types of things when you’re in the middle of a nightmare. (I’m not a big believer in spirits.)

For other types of nightmares, I scripted a better ending, one that was nurturing or healing. This took a lot longer, but, again, it was worth the effort.

The suggestion in the article about going over the “script” or solution several times during the day would’ve helped me a great deal – and saved me a lot of time. I did all this on my own and found out later that it is an established therapy.

It is worth noting that as the nightmares went away, one by one, I was able to learn about and deal with the cause behind each type. (Again, on my own.) Professional help proved ineffective, to say the least.

Thanks for publishing an article on this important topic.

Thanks for the links! My grade school age son frequently has nightmares. I’m going to try these techniques with him to see if it helps.

Chowes: “CHRISTMAS is a transcendent self; HALLOWEEN is reversed into the most decasent display of parts of all of us.”

I associate Halloween with children going house to house getting candy, adults playing fun roles for a night with their peers, reruns of classic horror films, fall leaves rustling under a cloud-swept full moon, and reading thrilling tales of terror from the masters like Poe, Lovecraft, Stoker, and Shelley.

I associate the American debasement of Christmas with riots on Black Friday at Wal-Mart over cut-rate flat-screen TVs, bought with increasingly overburdened credit cards; obscene bonuses going to stuffed suits and rapacious short-sellers on Wall Street while New York’s deinstitutionalized mentally ill and indigent freeze on the streets; obese children screaming at their parents for buying them the wrong $60 video game; and the appearance of holiday flyers and store decorations right after Labor Day. If there’s a holiday in America that brings out its most self-absorbed, malevolent, decadent side, it’s Christmas.

But that’s just my view versus yours. Now if you’ll excuse me, I have to become part of some partygoers’ nightmares as famed gun fetishist, booze-and-drug abuser, and gonzo journalist Hunter S. Thompson. Selah.

As someone who remembers her dreams on an almost nightly basis, I feel how it can influence health when too many of those dreams are disturbing. I have both once- in-a- while nightmares and recurring dreams. Sometimes I have dreams that aren’t terrible in nature but are highly complex and I wake up feeling like I did not get a good night’s sleep. Rewriting my dreams is something new I can try. I’ve already done talk therapy and stoic acceptance. Neither of those have done much for me. Accepting that working things out in my dreams is a healthy way to process my demons is one thing I tell myself to feel better. But, all the dreaming just gets tiring sometimes!

During college and – with diminishing frequency – for about 20 years after graduating, I had the very common “final exam day” dream in which I wander around campus looking for the site of an exam for a course that I neglected to attend even once during the whole semester. Somehow I think that if I can make it to the exam, everything will be alright, but I have no idea where to go. It was always the same. I would walk up to strangers randomly and ask them if they knew where the exam is being held. No one ever knew, of course. I never encountered anyone I knew in those dreams, only strangers. Finally, I had the dream and it was different. I encountered my pre-med advisor, a man I greatly admired. He scolded me sternly (quite out of character…) and told me that the situation was all my fault, and that I should have known better, etc. I never had the dream again. It’s been over 10 years since that last time.

I knew somebody once that would whine about having had a nightmare but it always turned that the big horror was something like “I het to teach my untergraduate seminar und when I looked down I wass not wearing trousserss!” (he was German, too, but that part was not his fault–I only include the detail in the fond hope that he will read this and recognize himself. Hi, Chris! Yes, I mean you, the one with the thin-on-top ponytail hair and the fat, sociopathic cat you gave the criminally dumb name of “Chester.” Those weren’t NIGHTmares, you MORon.

I’ve reconstructed my dreams also, by structuring a scenario where I stand up to the horribles and the attackers. It sounds really wacky, but it worked!! I was able to push back the attackers, and after only a few rounds of a creative video game-type scenario, the nightmares went away and I slept a lot better. It really, really, works. Try it.

David Chowes, New York City October 31, 2008 · 3:22 pm

[Re: Comment #8 by ‘Schizohedron]

I agree with you!

As a kid in the 50’s Holloween was a far more gentle day than it presently manifests itself. It was mainly a delightful holiday for children (sometimes escorted by their parents). Fun! Now, well you know… Quite different.

When I spoke of Christmas, I was speaking of the transcent hopes of all of us — not just people born into the faith.

And, yes, Christmas is mentioned more in terms as a barometer of the health of the retail economy than the mythic, subliminal and important aspirations it truely is about. [Supply side economics.]

Your comment on Hunter S. Thompson cuts to the bone. We all carry aspects of him — both the good and the bad;
the other wordly and its antithesis.

Enjoy this evening and tonight…

I will indeed, David — I read your meaning on the Christmas holiday. Any tradition, it seems, can still have a nugget of tradition, even if commercialism or morbidity has obscured it. (And there’s definitely a commercial aspect to H’ween; those costumes and mini-Butterfingers don’t manufacture themselves!) Be safe and enjoy the weekend, however you choose to celebrate it!

My boyfriend suffers from post-traumatic stress and insomnia. His doctor’s prescription? Ambien. It does help him sleep for about 6 hours (about 5 nights a week), but he still has nightmares. Ironically, he can cope with it himself simply because he comes from a family of dream interpreters (not the kind that get their info from dream dictionaries). Maybe because he believes they have purpose, that he can have control by deciphering them, his nightmares are occuring less and less.
I don’t think he would agree with attempts to rewrite one’s dreams or history. Some may find his method strange, but he thinks therapy is a strange solution. He would never NEVER seek out a professional or dictate his nightmares to anyone.

When it comes to horror films, I agree that the horror is in your head, not on the screen. But the horror is not necessarily the result of your brain imagining something wildly horrific . The horror is only the unknown, the fear that something BEYOND your knowledge will be introduced to your consciousness, and that you will be unable to bear the horror of it. Nightmares are very different–a culmination of images already lurking in your memory scary enough to wake you up, heart pounding, sweating, and reaching for the light. I think that’s the really disturbing part about nightmares, it is not something pieced together from the imagination or experiences of a director but something created by your own observations and unchecked thoughts.

I had only once, thank goodness, the nightmare where I thought I was awake with aliens or something coming in and I was paralyzed. It was EXTREMELY real…I truly thought I was awake. I know there’s a name for that kind of dream…I forgot what it was, but I hope to never experience that again!!

My daughter (4 years old today!) was having nightmares so we started an occasional bedtime ritual, in which she pulls the nightmares out of her forehead and puts them in mine to hold while she sleeps. She has fun seeing me get silly-scared by them and it seems to help her not have them. We also talked about how she could ask the monsters nicely to leave her alone while she’s sleeping (yes, in her dream), and that may have helped too. Besides her (and us) getting better sleep, it’s great to see the look on her face when she thinks she’s pulled the dream out. Maybe she really has :)

I have had very similar experiences to #1. I greatly enjoy zombie films, books (World War Z is a modern classic) and entertainment. As such, after dreading sleep following a particularly stressful day, I have begun looking forward to these dreams. They have shed their nightmarish quality, as in each, I am rationally approaching the situation, always escaping or taking out the zombie before he has a chance to do any harm. It’s really quite interesting, and more than a little morbidly entertaining.

Repeat this mantra if you see something scary:

“Don’t have a nightmare about that.”

A long time ago I noticed I could get nightmares from “watching” (but not paying much attention to) horror movies. If I half-watch something scary, and it could be an unpleasant image from the news, I run the risk of experiencing it in a dream. Thinking the mantra to myself has worked for many years.

This technique does not eliminate all frightening dreams but it nips in the bud the ones that can come from television.

Another technique I am able to use is lucid dreaming. This worked for a repetitive dream I used to have when I was young, which was clinging to a cliff or some great height. When I learned to let go and just fall, it would be terrifying right up to the “impact” (which never came) but at least the dream would end. Now I sometimes dream I am on a swaying building. Shades of 9/11? It’s still awful, falling, but at least the dream ends.

Yet another technique is shaking my head or at least trying to. It works better than trying to scream, which just results in a snoring sound. However, even the snoring sound confirms for me that I am dreaming and I can get out of this. By about the third attempt to shake my head I can “shake” myself awake. I think this works because we can still talk in our sleep, which means that our muscle control is still intact to some extent above the shoulders.

None of these techniques help with that annoying “getting shot to death” dream. But at least that is over quick and I wake up.

Don’t fall asleep during the news, and don’t have that extra helping of food right before bed.

For years, as a child and through college, i had persistent nightmares so vivid i would wake up with tears running down my face and screaming. I would also wake up covered in bruises from thrashing around in my sleep. Often, i would sleepwalk and my parents would find me walking around, and i would carry on a conversation with them in my sleep. I even tried to leave the house a few times (thank god my dad caught me!)

I finally went to a neurologist for help after years of not sleeping well, and they sent me to a sleep clinic for a night time sleep study and a day time sleep study.

Turns out, i have a rare form of epilepsy called autosomal dominant nocturnal frontal lobe epilepsy as well as narcolepsy, both of which cause hallucinations. I was placed on medication for both and the sleepwalking has stopped, the sleep talking has gotten much less frequent, and the vivid nightmares occur FAR less frequently.

I wish i had gone to the neurologist earlier, and not listened to my general practitioners who repeatedly told me i would grow out of it. I never realized what it was like to get a good nights sleep!

David Chowes, New York City October 31, 2008 · 5:41 pm

[Re: Comment #14 — ‘Schizohedron”]

Thanks — U2!**

Note** Not the rock group (which I like) — but, “You too!”

When I was kid, I used to have “being chased” dreams, where I was being chased by something so horrible all I could do was flee, and so I would dream about running and running from some nameless fear. These stopped when I was able to convince my dreaming self to stop running.

Since then, I have never really had any real nightmares. I just face whatever it is, and it goes away.

I adopted a severley abused puppy who often has nightmares. It’s heartbreaking to watch him yelp and cry in his sleep.

I have been trying to give him positive associations ( = lots of hugs and treats) with formerly terrifying situations (strange men, bathrooms, chains, metal or wooden bars .. ). I’m hoping that this will extend to his dreams too.

Jesse (#17), my 5 year old son was complaining about having nightmares and bad dreams around a year ago and we also developed a bedtime ritual which consists of spraying “magic water” in his room. This is only tap water with a few drops of perfume which we spray around his bedroom, and especially aimed at the window and it is supposed to keep the nightmares outside. Next, we apply “Sweet dreams powder” to his eyes, which is nothing but “invisible” powder which I “get” from a “magic store” and comes in many flavors, from vanilla, to strawberry to the flavor he chooses every night. So far it has worked wonders for him and has almost never complained again about having bad dreams in the last year.

Ruth Folit, www.lifejournal.com October 31, 2008 · 6:53 pm

As a long time journal keeper , I read into this article the literal meaning of “rewriting” to include actually writing the new dream script. Researchers (e.g. James Pennebaker, PhD) have shown that writing about meaningful life events can create physiological changes–increasing immune system functioning, lowered blood pressure, etc.

I would think that by writing on paper or keyboard the new script of a nightmare– to turn it into a more benign and perhaps positive dream– becomes even more powerful. The new script is physically accessible and can be reread several times throughout the next few days, to make the images clearer and further etched into one’s being.