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I am reposting a slightly revised post I wrote a while back on how to prevent nightmares. I've been having a lot of Covid-related nightmares recently, so I did it on myself and it worked very well. I also use it with clients who have trauma-related nightmares.
One of the most interesting things I've learned from doing trauma therapy is that some of the most painful symptoms have surprisingly simple fixes. For instance, nightmares.
Like a whole lot of psychological problems, it's hard to understand exactly how horrible trauma-related nightmares are if you've never had one, or never had many of them. It's not just the factual content of the nightmare, it's the emotional content-- terror, horror, helplessness, despair. And it's not just the emotional content, it's that unlike in real life, when you can do various things to calm yourself down or put a little distance between yourself and your feelings, in a nightmare, there is no distance, no perspective, and no control. You're not just re-living the worst moment of your life (or something that feels like it), you're re-living it without any of whatever you used to protect yourself emotionally when it was really happening.
And while all that horrible stuff is going on in your head while you're asleep, your body reacts to some degree or another as if it's really happening. Even if you don't thrash around or make a sound, you're liable to sweat, have tense muscles, grit your teeth, etc. So when you wake up, your jaw hurts, your head aches, your whole body aches, you're more exhausted than you were when you fell asleep, you're anxious and depressed, maybe you're sick to your stomach, etc.
And all of that is what you have to look forward to when you think of going to sleep. Even if you don't have nightmares every night, you might have one any given night. That, of course, does not generate the kind of relaxation necessary to fall asleep.
People who have trauma-related nightmares often stay up for nights on end, can't sleep even if they want to, drink, do drugs, and are chronically sleep-deprived-- which makes you depressed, exhausted, anxious, and often gives you physical health problems.
Nightmares: really bad news!
What I like to do with my clients in their very first session is find out one upsetting symptom that I can help them with immediately. The idea is that they'll get some relief right away, which will both be nice for them and also prove to them that therapy can help.
People need hope. I can believe in hope for them when they don't believe it yet. But it's better if they can change something right away. Luckily, there are several extremely upsetting and painful symptoms which can often be improved quickly and easily. I usually do grounding in the first session, as that has immediate results that they can observe within that session. But I always ask about nightmares, because I can get them started on imagery rehearsal therapy right away.
I didn't learn this in school or at the traineeship. I looked up specific treatments for nightmares, and I found one that had been tested in veterans and showed good results. I figured if it worked for vets, it would probably work for rape/abuse survivors. I modified it a bit, as it was designed to be used in a group and I only see individuals. But the group aspect doesn't seem essential or even important.
A lot of my clients have found it to be very helpful. It's very simple and non-stressful, unlike a lot of stuff I do, and my clients tend to enjoy it.
There are two ways to do this technique. The first is to modify an existing nightmare. The second is to create a new dream.
1. Modifying a nightmare.
If there are specific recurring nightmares, pick one that's medium-bad (not the worst one!) and write it down, narrate it, or imagine it in vivid detail, first-person present tense: "I'm walking in an alley..."
Pick a way to change the nightmare to something you'd like to dream about. Starting at the point where you'd like the dream to change, start writing about the change. For instance, maybe you defeat the bad guys instead of them killing you. Maybe they turn into a bunch of pumpkins. Maybe as they get closer, you see that they're actually your friends.
2. Creating a new dream
Create a completely new dream with nothing to do with the nightmare. The new dream should be something nice that you'd enjoy dreaming about.
(I have yet to have anyone try to change a nightmare. So far my clients have all chosen to script a new dream. So the "write out existing nightmare" step is skipped.)
Creating the new dream
This part is the same, regardless of whether it's a new dream or an altered dream.
Write down, narrate, or imagine the new dream or changed dream in vivid detail. Use all your senses: sight, sound, smell, touch, maybe taste.
I have my clients do this in session. I have them describe it aloud rather than write it out. They can write it out later if they want. The writing part doesn't seem necessary.
Spend three minutes twice a day imagining the new dream or changed dream. Close your eyes and try to feel like you're really dreaming it. Make it feel "dream-like." Do not do this right before you fall asleep, or at least don't only do it right before you fall asleep. Do it when you're fully awake.
DO NOT practice the nightmare! Only practice the changed or new dream.
My clients haven't usually dreamed the new dream. But their nightmares have gotten much less frequent or gone away when they've done this consistently. It usually takes a week or two of consistent, daily practice to start seeing results.
I really enjoy hearing my clients' new dreams. "Beach vacation" is a popular favorite. I ask for lots of details on the new dream, to really fix it in their minds.
Ideally, I time this so we close the session with the new dream. Clients often find this a very enjoyable experience, so they leave on a high note.
One of the most interesting things I've learned from doing trauma therapy is that some of the most painful symptoms have surprisingly simple fixes. For instance, nightmares.
Like a whole lot of psychological problems, it's hard to understand exactly how horrible trauma-related nightmares are if you've never had one, or never had many of them. It's not just the factual content of the nightmare, it's the emotional content-- terror, horror, helplessness, despair. And it's not just the emotional content, it's that unlike in real life, when you can do various things to calm yourself down or put a little distance between yourself and your feelings, in a nightmare, there is no distance, no perspective, and no control. You're not just re-living the worst moment of your life (or something that feels like it), you're re-living it without any of whatever you used to protect yourself emotionally when it was really happening.
And while all that horrible stuff is going on in your head while you're asleep, your body reacts to some degree or another as if it's really happening. Even if you don't thrash around or make a sound, you're liable to sweat, have tense muscles, grit your teeth, etc. So when you wake up, your jaw hurts, your head aches, your whole body aches, you're more exhausted than you were when you fell asleep, you're anxious and depressed, maybe you're sick to your stomach, etc.
And all of that is what you have to look forward to when you think of going to sleep. Even if you don't have nightmares every night, you might have one any given night. That, of course, does not generate the kind of relaxation necessary to fall asleep.
People who have trauma-related nightmares often stay up for nights on end, can't sleep even if they want to, drink, do drugs, and are chronically sleep-deprived-- which makes you depressed, exhausted, anxious, and often gives you physical health problems.
Nightmares: really bad news!
What I like to do with my clients in their very first session is find out one upsetting symptom that I can help them with immediately. The idea is that they'll get some relief right away, which will both be nice for them and also prove to them that therapy can help.
People need hope. I can believe in hope for them when they don't believe it yet. But it's better if they can change something right away. Luckily, there are several extremely upsetting and painful symptoms which can often be improved quickly and easily. I usually do grounding in the first session, as that has immediate results that they can observe within that session. But I always ask about nightmares, because I can get them started on imagery rehearsal therapy right away.
I didn't learn this in school or at the traineeship. I looked up specific treatments for nightmares, and I found one that had been tested in veterans and showed good results. I figured if it worked for vets, it would probably work for rape/abuse survivors. I modified it a bit, as it was designed to be used in a group and I only see individuals. But the group aspect doesn't seem essential or even important.
A lot of my clients have found it to be very helpful. It's very simple and non-stressful, unlike a lot of stuff I do, and my clients tend to enjoy it.
There are two ways to do this technique. The first is to modify an existing nightmare. The second is to create a new dream.
1. Modifying a nightmare.
If there are specific recurring nightmares, pick one that's medium-bad (not the worst one!) and write it down, narrate it, or imagine it in vivid detail, first-person present tense: "I'm walking in an alley..."
Pick a way to change the nightmare to something you'd like to dream about. Starting at the point where you'd like the dream to change, start writing about the change. For instance, maybe you defeat the bad guys instead of them killing you. Maybe they turn into a bunch of pumpkins. Maybe as they get closer, you see that they're actually your friends.
2. Creating a new dream
Create a completely new dream with nothing to do with the nightmare. The new dream should be something nice that you'd enjoy dreaming about.
(I have yet to have anyone try to change a nightmare. So far my clients have all chosen to script a new dream. So the "write out existing nightmare" step is skipped.)
Creating the new dream
This part is the same, regardless of whether it's a new dream or an altered dream.
Write down, narrate, or imagine the new dream or changed dream in vivid detail. Use all your senses: sight, sound, smell, touch, maybe taste.
I have my clients do this in session. I have them describe it aloud rather than write it out. They can write it out later if they want. The writing part doesn't seem necessary.
Spend three minutes twice a day imagining the new dream or changed dream. Close your eyes and try to feel like you're really dreaming it. Make it feel "dream-like." Do not do this right before you fall asleep, or at least don't only do it right before you fall asleep. Do it when you're fully awake.
DO NOT practice the nightmare! Only practice the changed or new dream.
My clients haven't usually dreamed the new dream. But their nightmares have gotten much less frequent or gone away when they've done this consistently. It usually takes a week or two of consistent, daily practice to start seeing results.
I really enjoy hearing my clients' new dreams. "Beach vacation" is a popular favorite. I ask for lots of details on the new dream, to really fix it in their minds.
Ideally, I time this so we close the session with the new dream. Clients often find this a very enjoyable experience, so they leave on a high note.
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Head-on: apply directly to the nightmare
[a combo of doing some guided meditation as a kid, and sleep disorders running in the family]
Now I can either steer out of them, or there's an involved preamble of "no, this is totes rl!" that makes the imagery fizzle out even as I wake up sobbing. I have been able to hyperventilate myself out of sleep paralysis, which was the real payoff until this spring brought a bumper crop of anxiety.
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Re: Head-on: apply directly to the nightmare
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I'm not sure if I'm surprised that something so seemingly simple obvious works (but the mechanism of effect is consistent with how brains work, so why shouldn't it) or that people don't think to do it on their own (but of course distressed people are not great at creative problem-solving on their own)... or amused that all us who've been instinctively consoling ourselves by writing self-insert fan and orig fic in which our avatars defeat thinly-veiled stand-ins for our own real-world fears and traumas, have been working this angle without knowing about the Official Technique.
I'm not sure what to do about my own weird version of nightmares, though. I don't have any nightmares often, but the few I do have, in about half of them the 'factual content' is benign but the emotional content is incongruously distressing, like a Hallmark movie with a horror soundtrack. Or if there is a distressing part of the plot and a comforting/empowered/amusing/enjoyable part of the plot, the emotional content is reversed or out of sync.
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Then I continued to have the recurring bad dream for years, but with much less emotional distress than before I reprogrammed the ending. It went back to being live-with-able, so I stopped doing intentional things to try to make it stop.
Then, some ten years later, I spent a few years writing fic from the perspective of a character (Finnick Odair from the Hunger Games) for whom my phobia (being in water) is his favorite thing in the world. I not only started to have way, way fewer dreams about drowning, but I started having positive dreams about being in the water, which had never happened before!
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Thanks for the report on prazosin. I kept mentioning it but I never had a client actually try it.
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About half the insomnia is fear of nightmares (the other half is agitation/brain overclocked) so this can but help. And I really appreciate your sharing your knolwedge with us, and that I can trust you as a source.
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So far, I haven't been able to get anyone in my family to try it, despite them having the exact condition it's meant to treat, but that seems to be part of a larger problem and not specific to this technique. If it ends up working for anyone I know who tries it, I'll be sure to let you know, Rachel. :)
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Nothing can work if you don't try it. (points at icon)
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Oh, that's funny. What a coincidence. Well, just know that I rec your post a *lot*, as
Nothing can work if you don't try it. (points at icon)
Yep. "The lightbulb has to want to change" gets said a lot in our house. We're still trying to work out that issue of not trying things.
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(I love that you're now far enough along in the Becoming A Therapist process that you can be a colleague I learn tricks and techniques from, that is really cool.)
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I am not having COVID nightmares (yet), I am just curious.
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I often memorise images. I struggle to make up/recall random images, but I almost always succeed in recalling specific ones, particularly ones I either see often (because they hang on my wall/are my computer background etc) or images that I've committed to memory as a deliberate act, so I have a narrative and an emotional connection that triggers the image.
Otherwise, if you can't consciously call up images, can you imagine smells and sensations and daydream your way through that?
My visual imagination has improved greatly since I've started to paint (being a non-visual artist is _hard_, but possible), but I was surprised by how many more visuals my brain has been serving up since then.
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