Friday, August 10, 2007

Does Dream Therapy Really Work?

This article was published yesterday, but I wanted to take some time to look into it a little further before I commented on it. Does Dream Therapy work for every person every time? No, but neither does FDA approved medications. Individuals respond as individually to therapy as they do to medication. There are proponents and opponents for Dream Therapy, depending on which theory of psychology/psychiatry you embrace. Here are some abstracts and criticisms about Dream Therapy.

My biggest question, I suppose, I that since research on this has been done for years, why is it just now making waves in the military? The VA published an article about this several years ago calling it Imagery Rehearsal Therapy. The VA’s report is mainly based on studies conducted at the University of New Mexico.

If you’re into study numbers like I am, here’s an in depth look at a 2001 study based solely on women with PTSD.

Dream Therapy also goes under the name of Cognitive Restructuring. Whatever you call it, even if it only has a chance of working, this opportunity should be afforded to everyone suffering from PTSD. While having bad dreams is only 1 of 17 symptoms of PTSD, dealing with the dreams, when present, are shown to positively affect other symptoms as well.

Dream therapy a coping tool for combat stress

Psychologist suggests it’s best to sleep through nightmares
By Kelly Kennedy - Staff writer
Posted : Thursday Aug 9, 2007 17:39:13 EDT

ASAD, Iraq — For 1½ years, Cmdr. Beverly Dexter’s husband gently shook her awake when she screamed in her sleep.

But one night, even as she begged him to wake her up in an unusual case of sleep-talking, he let her continue her nightmare.

She never screamed in her sleep again.

Now the combat psychologist says she may have a key to help those who never sleep through the night because they wake themselves rather than face dreams about the battlefield deaths of their buddies, the disturbing images of Iraqi — or Vietnamese — children handling explosives, or even traumatic scenes from their own childhoods.

“There’s no such thing as a bad dream,” said Dexter, chief of the Combat Stress and Readiness Clinic at Al Asad Air Base. “You’re working through things when you sleep.”
Though Dexter is careful to say she needs to do more research about her theory and that her book, “No More Nightmares,” will not be published until she retires and is able to look at it more closely, she’s excited that veterans have told her their dreams have disappeared within a day of her sleep-therapy lessons, which she teaches here in a classroom-type setting.

Military officials say they want to see more case studies and proof that Dexter’s theory works before commenting on it or recommending it. Dexter is the only therapist who uses her program, which she calls Planned Dream Intervention.

Even Dexter, a fellow of the American Academy of Experts in Traumatic Stress, said she is not yet sure why the therapy works, though she has ideas. And word has gotten around. Troops recommend it to each other, chaplains have come to her for advice on how to use it and other therapists send their clients to her to try to rid them of never-ending sleepless nights, she said.

“I know this works,” she said. “I know it sounds ridiculously too good to be true, but it is.”

After her husband let her sleep through her nightmare, Dexter said she woke up refreshed and stunned to hear she had even had a bad dream.

As she thought about it, she realized people don’t wake up out of good dreams — no one wakes screaming after winning the lottery. So, when she woke up in a foul mood after an odd dream where the Roman Colosseum — traveling on a pickup truck — began crushing the truck, she wondered how she could make it a happy dream.

“I know,” she said, snapping her fingers and speaking with her whole body as she does when she gets excited. “What if the bricks became hundred-dollar bills?”

That night, she did not wake up. This was significant, she said, for a woman who had suffered nightmares almost nightly since she was 4.

The more she thought about it, the more she realized her solution was more about empowerment — about resolving the bad situation in the dream.

“You have to think, ‘What do I want to happen next?’” she said. “But I don’t know if it’s getting back into the dream and finishing it or the waking resolution that works.”

Soon after Dexter’s peaceful night, clients — as usual — complained of nightmares, and she began asking them to think of scenarios where those dreams could become good. She told them to work only with the point where they woke up — not to rewrite the dream — and think about what’s next. She had them write down the positive outcome, then read it before they went to sleep.

It worked, she said. People began sleeping through the night.

In one case, a woman Dexter said she had helped sleep through dreams of childhood abuse woke up in the middle of such a dream when her alarm clock chimed. In the new dream, however, the woman went into the dream as an adult and saved her younger self from her abuser, Dexter said.

At the Naval Medical Center in Portsmouth, Va., where Dexter works when she’s not deployed, most of her patients deal with combat stress, and she has used the new therapy with them, she said, with good results:

* A soldier suffering combat dreams began sleeping through the night — and stopped spanking his children. Dexter wonders if he resolved his anger issues by finishing the dream.

* A woman had a nightmare that she kicked her boss’s head off. The next day, she thought about him sprouting a new head and apologizing for his bad behavior, and she slept through the night.

* A woman who woke up through 25 years’ worth of sexual-abuse dreams began sleeping through the night.

* A Desert Storm veteran suffering for 10 years with a nightmare about watching civilians die — something he had seen in reality — came up with a new outcome, slept through the night and made peace with the idea that he had done the best he could in that long-ago situation.

* A Marine who dreamed about hurting his daughter at first refused to try Dexter’s therapy because it seemed “flaky.” Out of desperation, he tried it and slept through the night — and stopped being afraid to be near children, she said.

Other troops’ flashbacks have stopped after they began sleeping through the night, she said.

In Iraq, Dexter offers a two-hour group therapy class to teach service members not to wake up during their nightmares.

Eight Marines and soldiers sat in one of her classes recently in the basement of a 399th Combat Support Hospital building. They ranged from a private with recent combat experience to a colonel who had been dreaming since Vietnam. Some seemed into the idea, and others looked skeptical as Dexter explained the process.

She told them their “sleeping brains” say, “I’m not going to let you go there” when a nightmare hits, and that they need to train themselves to sleep through it. In a combat zone, where people remain hypervigilant, that can be tough, but she compared it to “potty training.” Parents teach their children to wake up when they feel bladder pressure.

With her process, people train themselves to think differently about nightmares.
“No one dies in dreams,” she said. “Even if a dream has incredibly shocking pieces to it, I have to trust whatever my sleeping brain is going to do. If you start sleeping peacefully through the night, you wake up more refreshed, and that can make you calmer during the day.”

And, she said, the brain may be using the nightmares to work things out as people sleep.

“Experts say that in dreams, you may forget what we don’t need,” she said. “If you stay asleep, you probably won’t remember your dreams. But we believe the brain biochemistry is doing balance work, and you have to let it.”

She also said it’s important not to interpret dreams. So, if a soldier dreams of killing a friend or sleeping with a loved one’s wife, it means nothing in real life, and allowing it to happen in a dream could work out anger or guilt issues people don’t realize they have.

She also told the service members not to worry about the violence or inappropriateness of the dream intervention they come up with. Early on, her therapy didn’t work with someone who dreamed about two friends he had seen killed in a gruesome way.

“I was shocked,” she said. “I thought, ‘What? The magic fairy dust doesn’t work?’”
She asked him about his intervention.

“He said, ‘I had the insurgent guys lay down their weapons and walk away,’” she said. “‘I’m not doing that violence thing.’”

But that, Dexter said, wasn’t gut-level enough. Still, he said he was a Christian and couldn’t gun the insurgents down, even in a dream. Instead, he had them float away as dust — which worked.

“Abstract is fine,” Dexter said.

But it has to hit at the “caveman” level because dreams are ancient ways to handle stress. In other words, a group hug in dreamland probably won’t do it, but fire-breathing dragons swooping to blast the enemy might.

Sometimes, the dreams make no sense. One client kept having a surgery dream that wasn’t a nightmare, but he also had pain in his leg that no one could find a cause for. But he liked his surgeon, so he didn’t understand the dream.

“Think caveman,” Dexter said she told the man. “On a subconscious level, this man cut you open and hurt you.”

In the dream intervention, the patient beat up his surgeon, and the dreams and the pain went away, Dexter said.

“I’ve had some really odd, remarkable pain that could not be explained disappear with the dream,” she said. “You just have to think, ‘What do I want to happen next?’ It’s like having magic fairy dust.”

Seven steps to planned dream intervention
* There is no such thing as a bad dream.
* Think only about the part of the dream that woke you up.
* Think, “What would I like to happen next?”
* Come up with a quick idea that feels right: Bashing the bad guy, turning spiders into golf balls and whacking them with a club, watching a dead friend enter an elaborate castle in the sky.
* Write it down.
* Read it before you go to sleep.
* If it doesn’t work, come up with another Planned Dream Intervention. The emotional level has to be the same as that of the dream.


Da Mommy said...
This comment has been removed by the author.
Anonymous said...

I have met this lady, what a nut!

Scully's Moulder said...

I haven't met the lady in question so I can't attest to her nuttiness, but I think there is some soundness in the majority of what she's putting out into the community. As a spacies and on the whole, we greatly underestimate the power of the brain. There are cases where we control it, i.e. dealing resiliently with a very stressful situation; and situations where it controls us, i.e. waking us with night terrors or certain "selective" amnesias.

Considering our limited understanding of how the brain works, what causes dreams, or how to interpret those dreams or even if they should be interpreted, I think it is way to early to rule out any kind of PTSD treatment. It may sound cooky to some, but so did snake oil years and years ago. Airplanes starte with the same thing, "If men were meant to fly, God would have given them wings."

All in all, Dream Therapy seems to be just one tool in a therapists tool belt. We try it. If the tool doesn't work, we try another tool. This tool is going to be as controversial as many commonly accepted tools already are. Some treatments for overcoming fears currently involve limited exposure to the trigger of the fear. For some, this is highly acceptable; and successful. For others it does nothing more than add additional stress.

Bottom line is, this, as with all other treatments, has to be agreed upon by both the therapist and the patient. To an extent, these treatments are almost faith based. If you believe it works, the chances of success increase greatly. This is seen repeatedly with placebos. But, since there's no real quantitative way of measuring success in controversial treatments while eliminating results for placebo effect, more study has to be done with the blinders off. In other words, we have to look at it without the concept that something is impossible. Measure the results as they happen and try to sort out the placebo cases later, if possible.

Even if it's placebo as the explaination, the patient probably doesn't care to any serious depth. What is important to them is that this particular symptom has stopped occurring or presents itself in a way that doesn't cause the stressor as it had before.