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Dexter is careful to say she needs to do more research about her theory and that her book, “No More Nightmares,” will not be published until she retires and is able to look at it more closely, she’s excited that veterans have told her their dreams have disappeared within a day of her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.

Human Growth and Development paper got an A

The paper got an A so I'm going to share it. I've taken out identifying information. I did not include the images. This paper may be used for educational purposes when cited correctly with permission from the author (that's me). Any reproduction for profit is prohibited without express written permission.


An Observation of Shane:
Physical, Cognitive, and Emotional/Social Development


Acknowledgments
My thanks go to Miss Michelle, Academy Director at XYZ Childcare, for allowing me to utilize her facility for this observation project, to Miss Dorothy, Assistant Academy Director, for coordinating my requests and efforts with Miss Michelle and for assisting me with the scheduling, and to Miss Erin, Shane’s Academy Caregiver and Teacher, for working with me, providing background information, and for setting up observable tasks that allowed me to observe Shane in several different areas of development and for changing her class schedule around to accommodate my requests. I also give my thanks to Shane’s mother for allowing me to observe her child. Mostly, my thanks go to Shane for being a fun, challenging, and interesting child, for accepting me as part of his classroom, for giving me an abundance of information to use in my report, and for behaving like himself while I was there.


Introduction
Shane is 4 years 5 months old. He is of African-American descent in a middle socio-economic status family. He has an older sister, 10 years of age, who has skipped 2 grade levels. His mother works nights and raises him without the presence of his father; however, an uncle lives in the house with them. Shane has been at La Petite for almost 2 years as a student.


Development in the Physical Domain
Shane appears to be of average height and weight when compared to other 4 year old boys in his class. He has chubby cheeks and does not appear to have retained more than normal baby fat. His physical build appears slender and the appearance of the “pot-belly” associated with this age group is diminishing. His overall physical health appears to be good as no evidence of illness or injury was observed. Overall, his physical growth and physical health appear to be normal for a 4 year old. Shane is toilet trained and easily recognizes the urge to go.
As it relates to gross motor skills and development, Shane appears to have solid control over the large muscle groups. After Shane finished lunch on my first visit, he placed his paper plate and cup into the trash. He then spun in circles back to his chair approximately 8 feet away. During my second visit, Shane was in the “Housekeeping Center”, and he accidentally dropped a toy over the edge of the counter. He stepped over or around 3 playmates and various toys, without falling or losing his balance, to get around the edge of the counter to retrieve his toy. The overall distance of clear floor from the edge of the counter to where the toy had fallen was roughly 12 feet. Shane began by hopping with both feet, gaining 6 to 12 inches with each hop. This continued for 10 hops, at which point he skipped in a tight circle completing each skip, 2 hops on each foot, 4 times. At this point Shane intentionally fell to his hands and knees and “scooted” the remaining distance to the toy, alternately pulling himself with both hands, then pushing with both feet. After Shane retrieved the toy, he stood up and galloped the entire distance of clear floor back to the center where he resumed playing.
Out on the playground, Shane begins his outside time by running around the perimeter of the playground. His running appears smooth and fluid. Shane swings his arms normally as he runs, the right arm swinging forward as the left leg moves forward, etc. Shane runs with his arms straight; however, this may be the result of the bulk of his coat. Shane now turns his attention to the playground equipment and he climbs the rope netting smoothly and without reservation, alternating his hands and feet as he ascends. He maneuvers across the playground equipment and descends using the slide. After he reaches the bottom, he gallops for approximately 30 feet before engaging in a full force run as he chases another child. While Shane plays line judge for 2 other children who are having a race, he jumps up and down until the race it over, roughly 30 seconds. Following the race, Shane engages in a full out run again as another child chases him this time. Shane goes back to the playground equipment and climbs the stairs alternating feet. He slides down the slide, then climbs the slide and descends the stairs on the playground equipment one foot at a time. While he should be descending the stairs alternating feet, his movement may have been impaired with other children in front of him slowing his progress. Also, Shane’s proficiency with stairs could be impacted by the absence of stairs at home. Overall, Shane’s gross motor development appears normal for that of a 4 year old.
As it relates to fine motor skills and development, Shane favors his right hand in every task I have observed. He eats, uses scissors, writes, draws, and manipulates a glue stick with his right hand. Shane can roll a plastic spoon between his fingers, but when he uses the spoon to eat, he does not hold it like a pencil in three fingers, but instead with the whole hand like a shovel grasping it with his fist. This is normal development, but by the end of 60 months, he should be holding eating utensils like adults. Shane does not drop food off the spoon while transporting the food to his mouth. Also, he can intentionally alter the amount of food he puts on the spoon depending on the size of the bite he wants. Shane can hold a full cup in one hand and drink from it without spilling. During his lunch, Shane had a “wardrobe malfunction” and his jeans came unsnapped and unzipped. He zipped up his pants easily, but had difficulty with the snap. On my second visit as the children were preparing to go outside to play, Shane put on his coat but could not connect the zipper pieces to zip it up. Miss Erin had to zip his jacket for him. During my second visit, however, when Shane was playing in the “Housekeeping Center”, he took the clothes off a toy he was playing with and put them back on without difficulty.
While performing an art task during my third visit, the task was to cut out pictures of food and glue them to a sheet of construction paper. Shane’s use of scissors is difficult and labored. He is using safety scissors by inserting the first two fingers of his right hand through the larger hole in the handle completely up to the knuckle of the hand and his thumb in the smaller hole in the handle, also up to the knuckle. Shane uses the larger muscles of his hand to open and close the scissors instead of the smaller muscles in his fingers to manipulate them. Shane holds a glue stick in his fist and uses his whole arm to manipulate it on the paper. This may have more to do with the size of the glue stick in relation to the size of Shane’s hand that it does with an inability to manipulate it like a pencil or crayon. It appears that Shane’s proximodistal development as it relates to fine motor control may de delayed slightly in this aspect. While most children can cut on a line with scissors by 48 months, as well as zip articles of clothing, individual differences in ability and personal interests will invariably cause advances and delays across a wide spectrum of developmental issues. If Shane is not cutting properly with scissors and fastening and zipping his clothes by 60 months, he should see a developmental specialist to se if the delay is caused simply by disinterest or if there is a physiological component.
Shane’s writing ability is above that of his peers. While writing he always holds a pencil or crayon in a 3 finger grip and uses the fine muscles in the wrist and fingers to write and draw. Only twice while Shane was drawing did I observe him grasp the crayon with his whole fist and use his entire arm to draw. (See figure 2) Shane’s print is neater and more legible than that of his peers and as figure 1 shows he is making attempts at cursive writing. This is normally not done until roughly the 3rd grade. Given Shane’s ability to write as well as he does, I am inclined to believe that he has the aptitude to use scissors properly but the task does not interest him enough to practice it.
Shane displays impressive verbal skill. The phonology and articulation of his speech is well above that of his peers. He does not show difficulty with “S+T”, “S+K”, “C+H”, or “T+H” combinations as the majority of children in early childhood do. He also does not substitute some letters for others like “W” for “R” or “T” for “S”. Shane’s annunciation of words is clear and he is easily understood. This indicates that not all of his fine motor development is delayed. He displayed no morphology during any of my visits. He did not pluralize words that should not have been pluralized, nor did he add “ed” to verbs that were already past tense and did not require it. This speaks to Shane’s cognitive development as it relates to language acquisition. Shane’s phonology and morphology are advanced for his age. When Shane is tired, excited, or distracted his syntax occasionally slips and he will use the incorrect conjugation of a verb like, “She don’t say that.” for “She didn’t say that.” or he will leave out small unimportant words like, “I have to go field trip.” or “I have to go bus.”. The pragmatics of Shane’s language use is appropriate for children of his age. Authority comes through in his tone and diction only when he
is speaking to peers who have interfered with his play like, “Go away, I said, Devon!” or when a playmate has taken something that is his like, “No, C.J., that’s my paper!” Meanwhile, his normal tone with adults is much more submissive, even when he is in disagreement with them. Shane’s syntax and pragmatics are normal for his age and indicate normal emotional and social development in relations to language skills.


Development in the Cognitive Domain
Shane’s attention is above average for his age. If he enjoys the task, like reading or writing, he will attend to it for as long as he is allowed. With tasks he does not enjoy, like using scissors, he shows difficulty in focusing on the details of the task and becomes easily distracted. Shane shows exceptional recall and recognition, well above the norm for children his age. During my first visit, Shane told me about many of the activities the children do at the Academy, the different centers in which the activities take place, the songs the children sing, and then told me his favorite activities and songs. He also showed me all the artwork in the classroom, even if it was not his. He even told me who the artists are, pointing them out in the class. He finished his tour by showing me the behavior chart and explaining how it works, and pointing out that his tag was still on green, meaning he had a good day. Shane can read on a late 1st grade early 2nd grade level and has a plethora of 4 and 5 syllable words in his vocabulary. Additionally, Shane shows the appearance of some memory strategies that are usually not typical for 4 year olds. As I was leaving from my second visit, which was on a Monday, Shane asked when I would be back. I told him I would return on Friday. He said okay and as he was walking away, I could hear him say to himself, “Friday, Friday, Friday, Friday.” This type of rehearsal usually does not occur until children are presented with material on which they will be tested later.
He shows a great deal of interest in cars and can name the make of a car if told the model. Shane asked me, “Gary, what kind of car do you drive?” I replied, “A van.” He asked, “What’s it’s name? What’s it called?” I replied, “A Town and Country.” Shane asked, “A Chrysler?” I said, “Yes, a Chrysler.” Shane can also name the make and model of all the cars that all the Academy staff drives.
Shane identifies scripts for familiar settings, tasks and places. For example, he knew he would be going on a field trip to the Super Bi-Lo. He explained to me the process of going on the field trip and what he expected to see once he got to the grocery store. Shane also displays a firm grasp on Metacognition. He is aware of his own mental processes and makes statements about his beliefs of abilities to perform tasks. When Miss Erin asked Shane during the art center task involving scissors, “Can you cut out the salmon and glue it on the paper like C.J. did?” Shane replied “No. I can’t.” Shane recognizes that he has difficulty with that task, and as I will show later, he also knows that this particular task causes a great deal of frustration within him.
Shane displays limited egocentrism and did not display any animalistic thinking during my visits. Piaget would suggest that these two behaviors are normal for 2 to 6 years olds. After Shane finally got the salmon cut out, he could orient the picture on his construction paper in the same orientation as another playmate at his table. Also, when he had difficulty with the scissors and with the task in general, he did not say something like, “The scissors are mad.” but he saw the difficulty as a personal flaw.
Shane can recite numbers in order 1 through 49 and can count backwards from 10 to 1. He can also recognize numbers 1 through 20 printed on cards or paper. When asked to hold up a certain number of fingers on one hand, he frequently holds up all 10 fingers. Shane does not show conservation of number or the concept of number in quantities larger than 3. This is normal for his age and is typical of a Piagetian preoperational child.

Development in the Emotional/Social Domain
Shane did display some interactive play during my second visit. He played alongside 3 other playmates in the “Housekeeping Center”. Shane’s play, for the most part, did not involve the other children, unless the playmates were commenting on Shane’s play or Shane was commenting on theirs. While Shane’s play was Sociodramatic, in general it was parallel play and it involved only him and his interaction with other playmates in the center was limited. Shane exhibited out loud private speech while he set up his play area, and he showed a strong imagination as he used one toy figure to fly around and carry another toy figure. As Shane gets older, his interactive play with peers will increase, and he will begin to interact with them more as they all take on pretend roles in pretend situations.
Erickson would say that Shane exhibits a sense of guilt at his difficulty with cutting and art tasks. As I mentioned earlier, Shane saw his inability to manipulate scissors properly as a personal flaw; he thinks there is something wrong with himself. To help Shane overcome this difficulty, it is crucial that caregivers and parents are not critical of Shane’s difficulty with the task, but provide warm and positive feedback so that he gains a sense of initiative and the guilt he feels over this task does not carry over to other novel tasks later on. Shane is very aware of his emotions as well. As the cutting task continued, his frustration became more and more apparent. Shane became so focused on the task and his frustration that he completely forgot that I was there observing him. As if the cutting task was not frustrating enough for him, when he decided to glue what he had cut up onto his construction paper, he could not find the sheet of construction paper. He asked the playmate next to him, “C.J., is that my paper?” pointing to C.J.’s piece of construction paper with 5 items cut out and glued to it. C.J. replied, “No. That’s my paper.”
At this point, Shane could not handle any more frustration. Even though C.J. was looking for Shane’s construction paper, Shane placed his face in his hands and slumped down in a moment of defeat. He began to cry due to his frustration and Miss Erin was there to check on him within 30 seconds. After Miss Erin calmed him down some, she began scaffolding her instruction with the scissors, limiting her intervention at first. By the end of her scaffolding, she was holding the paper so Shane could cut out the salmon without having to dual-manipulate the scissors in one hand and the paper in the other. Again, Shane’s frustration increased and he began to cry and after Miss Erin asked Shane if he wanted to try again later and Shane agreed, was prompt to end the task for Shane and, shortly after, the rest of the class. Shane was so frustrated with this task that he told Miss Erin, during his second bout of frustration, “I don’t want to go to Kindergarten.” because he would be using scissors in Kindergarten as well. While he was crying he said to Miss Erin, “I’m a crybaby!” and Miss Erin assured him that he was not. This was self labeled name calling. No one in his group called him that. In fact, in the Academy, “crybaby” is a bad word and I never witnessed Shane say it unless he was tattling.
A few minutes after the cutting task had ended and Shane was calming down, he turned around and noticed me there still observing. At this point, a realization came over him that I had been there the entire time through his difficulty with the cutting task and crying. Shane became very embarrassed, his face turned red and he began crying again. Shane became even more frustrated as he could not stop himself from crying despite his attempts at covering his mouth to stifle the noise. This shows that Shane is aware of his own emotions and in fact has feelings about those emotions. Some contemporary psychologists refer to this as Metaemotion. This assessment is further reinforced by a conversation that Shane initiated with me 5 minutes later after he had calmed down again. I believe this conversation was to convince himself as much as it was to convince me. Shane said:

“Gary?” I replied,

“Yes, Shane?”

“I’m sorry, Gary.”

“You’re sorry? What are you sorry for?”

“I’m sorry that I cried, Gary. I’m not a crybaby.”

Shane is not only capable of recognizing emotion in himself, he also grasps the basics of emotions in other people and will say things in attempts to manipulate those emotions in an effort to produce a desirable outcome for himself. During my last visit, Shane engaged me in conversation about the theme of the day. Shane did not show interest in drawing construction tools with his playmates. I asked him, “Can you show me how to draw a hammer?” Shane replied, “No. I can’t. It’s too hard.” As I encouraged him to follow Miss Erin’s instruction and draw some tools in his journal, he became somewhat irritated with me and said, “That’s it, Gary. It’s over. It’s over, Gary. We’re not friends anymore.” This play on guilt is typical behavior for 4 year olds. Unable to avoid interaction, I convinced Shane to draw a picture of himself if I sat next to him. He then volunteered to draw a picture of me. (See figure 3)
As I was packing up to go from my last visit, Shane asked if he could go with me. I told him that he couldn’t because that was against the rules and that I would get into trouble if I took him with me. At this point, Shane attempted to convince me that he could go with me by saying, “No, Gary. It’s not in the rules. You won’t get in trouble.” While this little bit of deception was not malicious, it is normal behavior. At about 4 years of age, children begin to recognize deception in others, especially adults, and occasionally attempt to use it to their advantage. Finally, Shane realized that I was not going to take him with me and said, “You’re ruining my life, Gary. That’s it. It’s over, Gary.” This is a second example in one conversation of a normal play on emotions. Overall, Shane’s emotional and social development are normal.