80% of people who suffer from PTSD have dysphoric dreams or nightmares that negatively impact their daily life and functioning. (Holziner et al., 2020) Lucid dreaming may have therapeutic benefits that can help people with PTSD who suffer from nightmares. I will argue that, it is not lucidity or awareness of one’s dream that reduces nightmare frequency or severity, but the ability to control one’s dream while lucid that has the potential for a therapeutic benefit. I will do this by reviewing five studies that look at the effects of lucid dreaming on nightmares with people who suffer from PTSD.
Spoormaker et al., (2003) sought to investigate lucid dreaming as a treatment for nightmares. They hoped to find that lucid dreaming would decrease nightmare frequency and anxiety, and improve sleep quality. Lucid dreaming was hoped to be an alternative method to imagery rehearsal because it was flawed with a high drop-out rate for people in treatment. Lucid dreaming is a cognitive skill where people can gain lucidity during a nightmare and change the dream to be more pleasant.
Spoormaker et al., (2003) had a small sample of 8 participants in 1 hour sessions for lucidity exercises and discussed solutions for nightmares. They measured nightmare frequency, sleep quality and anxiety through self-reports. They defined nightmares as dreams provoking anxiety but not necessarily being woken up. One exercise was to intend to realize they would be in a frightening situation, that it was not real but a dream and that anything could be changed.
Spoormaker et al., (2003) found that after two months nightmare frequency decreased, sleep quality increased but no change in anxiety. They concluded that lucid dreaming was an effective technique to reduce nightmare frequency but were unclear as to the causal mechanism behind the results. 6/8 of the participants reported less nightmares but only 3 were actually lucid and the others the nightmare changed without lucidity. The small sample size meant that the results were not significant. They explain how there may be a degree of skill in overcoming nightmares to explain the results; maybe those with self-efficacy in changing dreams are more successful. They identified the limitation of sample size and how a larger sample with a control group is necessary to compare the groups. They identify the significance of lucid dreaming for it can easily be included in existing therapy.
Spoormaker and van den Bout (2006) conducted a pilot study to evaluate how effective lucid dreaming is on nightmares as a cognitive restructuring technique. They identify how if one can become lucid during a nightmare, they have the ability to change the story of the nightmare while the nightmare is occurring. The motivation of this study was to conduct a randomized controlled methodology to evaluate the effectiveness of lucid dreaming for people with PTSD experiencing nightmares. Here, nightmares were defined as a frightening dream that woke the person up.
Spoormaker and van den Bout (2006) had 23 participants complete mail-in self-reports before and after treatment on sleep and symptoms of PTSD. The sample was randomly assigned to three groups: a one 2 hour individual lucid dreaming session, a one 2 hour group lucid dreaming session, and the other group was on a waiting list. The sessions included lucid dreaming exposure, master and exercises. Participants were instructed to intend that when they were faced with a recurring nightmare, they would realize it was a dream and were told they could change anything. They discussed different dream endings and were encouraged to choose a triumphant ending.
Spoormaker and van den Bout (2006) found that nightmare frequency decreased for both treatment groups. Sleep quality and PTSD severity did not significantly change. However, they found that lucidity was not needed for reducing nightmare frequency. They concluded that lucid dreaming does reduce nightmare frequency but are unsure which mechanism, exposure, mastery or lucidity, was responsible for it. Of the 7 participants whose nightmares reduced, only 4 were lucid and changed the nightmare. Limitations of the study were the small sample size leading to no statistical significance, inability to analyze comparison of treatment groups, lacking long term follow up, and unclear causal mechanism. Only 6 out of 16 could achieve lucidity in the nightmare and change the dream. They also identify a need for experimental evidence to determine the causal mechanism leading to therapeutic effects.
Harb et al., (2016) looked at the role of lucid dreaming in terms of imagery rehearsal therapy for military veterans who were suffering from PTSD with recurring nightmares. Image rehearsal therapy has the patient identify a target within the nightmare itself and rescript that part while they are awake then imagine the new dream before falling asleep. They wanted to know how changes in lucid dreaming constructs would be impacted by imagery rehearsal by turning the nightmare into a positive dream. To do so, they compared a group of veterans who received CBT-i treatment to those who had imagery rehearsal and hypothesized that only those with imagery rehearsal would induce lucid dreaming compared to CBT-I.
Harb et al., (2016) used 33 participants and enrolled them in a randomized controlled trial that compared two forms of treatment of PTSD recurrent nightmares: Cognitive behavioural therapy for insomnia and CBR-i plus imagery rehearsal. 26 participants completed their randomized treatment and seven dropped out. The person assessing the participants for PTSD was blind to the treatment assignment. Self-report scales were used to determine lucid dreaming awareness, control, self-arousal from dreaming, nightmare frequency and distress, sleep quality and symptoms of PTSD. All five self-report measures were administered before treatment and 1 week before the end of the study. Treatments were six weekly, 1 hour sessions with a psychologist.
Harb et al., (2016) found a negative correlation between dream content control and nightmare distress. As control over dream content increased, there was a reduction in being distressed from nightmares. The aspect of controlling one’s dreams within lucid dreaming demonstrated positive contribution therapeutically for people suffering from nightmares from PTSD. Only for the imagery rehearsal + CBT-i group was dream content control related to decreased nightmare distress. Limitations of the study were if the data was from controlling the dream or being aware in the dream and the sample had selection bias to military personnel. Lucid dreaming is significant and an important area of research because nightmares do affect many people with PTSD so understanding the therapeutic mechanism is important for those who suffer from this condition.
Holziner et al., (2020) conducted a study whose goal was to evaluate the effectiveness of lucid dreaming therapy for people with PTSD. Lucid dreaming therapy is a means of cognitive-restructuring that is applied while in the state of dreaming. The dreamer develops the technique of being aware of and able to change dream content. They hoped that learning lucid dreaming as a technique would enable people to autonomously regulate nightmare occurrences and content to reduce suffering by changing the storyline of the nightmare while dreaming. In this study, they wanted to evaluate lucid dream therapy for PTSD nightmares and determine if nightmare frequency was reduced.
Holziner et al., (2020) used a sample of 31 participants who were suffering from nightmares and were randomly assigned to the Lucid dream or control condition. A sleep diary was used for the 6 week treatment. The lucid dreaming condition had 1 hour weekly sessions over 6 weeks where two therapists where scenes within the dream were discussed that the dreamer could have become aware of, what they could have changed in the plot of the dream and psychoeducation on lucid dreaming. Several self-report scales were used before and after treatment to measure sleep quality, daytime sleepiness, quality of life, psychological and traumatic event distress, depression and the severity of their nightmares.
Holziner et al., (2020) did not confirm their hypothesis finding no significant difference between the lucid dreaming group and the control. There was no correlation between reducing nightmare severity and measure of PTSD or nightmare reduction. They did find a significant reduction in anxiety and depression in the lucid dreaming group after treatment. They addressed that the lack of results may be due to only having three months of treatment when PTSD is much longer lasting as a condition meaning more treatment may be necessary to see results. Some limitations are the high dropout rate leading to a small sample size. They also identified a risk with psychotic patients where lucid dreaming can induce delirium and hallucinations. The significance of lucid dreaming is the hope that it can be a tool for people who suffer from frightening nightmares by activating self-responsibility and control. The advantage over other therapies is its situationally relevant application, being used while the nightmare is occurring instead of an after the fact treatment. (Holziner et al., 2020)
Yount et al., (2023) found that after a lucid dreaming workshop, people who suffered from post traumatic stress disorder dramatically reduced the severity of their PTSD symptoms and nightmares, and improved wellbeing.
Yount et al., (2023) recruited 49 adults through print, social media and radio ads who were suffering from PTSD to participate in a six day, 22h online lucid dreaming workshop that taught lucid dreaming induction techniques, psychoeducation on lucid dreaming, relaxation and mindfulness practices and sleep hygiene. Several self-reports were used to determine the severity of PTSD symptoms including nightmare distress, wellbeing and positive/negative affect. Saliva samples were also collected before and after the lucid dream occurred and were compared to control participants who did not have healing experiences.
Yount et al., (2023) found that 37, or 76%, of the participants induced at least one lucid dream and 25 of them reported a healing effect. There was no significant difference between those who had or did not have a lucid dream and there were no significant differences between the three groups. They identify that the workshops were effective in teaching the participants to induce lucidity because of the high rate of participants who were able to do it. The main finding they found was that lucid healing experiences reduced PTSD symptoms, nightmare distress, and negative emotions and increased their wellbeing. They also found in the saliva that after two healing lucid dreams there was evidence of stress relief compared to non healing lucidity. They found that nightmare frequency and distress significantly decreased after the workshop and was maintained 1 month after. They found that positive outcomes/effects were not contingent on dream lucidity showing that lucidity may not be necessary for reducing nightmare frequency or distress. They also found that the workshop increased wellbeing and decreased negative affect. Limitations were not controlling for specific techniques used by participants and the use of self-reports for evidence of lucidity. The significance of this study was that it may not be awareness that one is dreaming that is the causal therapeutic mechanism but something like dream control.
In conclusion, all of the studies presented here were lacking in sample size which impacted the significance of the results in a negative way. With small sample sizes the problem of no statistically significant findings is a serious problem. Future studies need to have more participants for results to be significant. Secondly, there were findings of nightmare frequency or distress decreasing (Spoormaker et al., 2003; Spoormaker and van den Bout, 2006; Yount et al., 2023) but it was unclear what the therapeutic causal mechanism was. There were cases where lucidity was not correlated with decrease in nightmare frequency or severity. (Holziner et al., 2020; Yount et al., 2003) We did see in Harb et al., (2016) as lucid dream control increased there was a decrease in nightmare distress. It is evident that mere lucidity is not enough to produce positive effects for people suffering from nightmares that have PTSD, but there is evidence that lucid dream control can have therapeutic benefits. It is therefore in the interest of future research to implement studies with sample sizes large enough to produce statistical significance and focus not on lucidity alone but the role of controlling one’s nightmares as the causal or therapeutic mechanism.
References
Harb, G. C., Brownlow, J. A., & Ross, R. J. (2016). Posttraumatic nightmares and imagery rehearsal: The possible role of lucid dreaming. Dreaming, 26(3), 238–249. https://doi-org.ezproxy.lib.torontomu.ca/10.1037/drm0000030
Holzinger, B., Saletu, B., Klösch, G. (2020) Cognitions in sleep: lucid dreaming as an intervention for nightmares in patients with posttraumatic stress disorder. Frontiers of Psychology. 21(11), 1826. doi: 10.3389/fpsyg.2020.01826.
Spoormaker, V. I., van den Bout, J., & Meijer, E. J. G. (2003). Lucid dreaming treatment for nightmares: A series of cases. Dreaming, 13(3), 181–186. https://doi-org.ezproxy.lib.torontomu.ca/10.1023/A:1025325529560
Spoormaker, V. I., & van den Bout, J. (2006). Lucid Dreaming Treatment for Nightmares: A Pilot Study. Psychotherapy and Psychosomatics, 75(6), 389-94. http://ezproxy.lib.torontomu.ca/login?url=https://www.proquest.com/scholarly-journals/lucid-dreaming-treatment-nightmares-pilot-study/docview/235469783/se-2
Yount, G., Stumbrys, T., Koos, K., Hamilton, D., & Wahbeh, H. (2023). Decreased posttraumatic stress disorder symptoms following a lucid dream healing workshop. Academy of Traumatology. Advance online publication. https://doi.org/10.1037/trm0000456
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