Section XX: Nightmares

What are My Dreams Telling Me? Keeping a Dream Journal

Goals of the Exercise

1. Create a coherent story to confusing dreams.

2. Immediately process emotional content through writing.

3. Fall back to sleep after distressing and/or strange dreams.

Additional Problems for which this Exercise may be Useful

Suggestions For Processing This Exercise With Veteran/Service Member

The “What Are My Dreams Telling Me?” activity is for veterans/service members experi- encing unpleasant or confusing dreams that interfere with their sleep or quality of life. It guides the veteran/service member in keeping a dream journal to bring to therapy sessions. Often the most helpful thing we can do is help identify possible meanings of dreams through Socratic questioning or help the veteran/service member brainstorm possible meanings. Follow-up could include bibliotherapy using books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or videotherapy using films suggested for “Inspiration” in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, published by John Wiley & Sons.

EXERCISE XX.A What Are My Dreams Telling Me? Keeping A Dream Journal

Dreams can be very confusing. All of us have, at one time or another, sat up in bed wondering what the dreams we just had meant. Dreams can seem illogical, nonsensical, and downright weird. Not only that, our dreams can sometimes become frightening, depressing, horrifying, or otherwise distressing, and can negatively impact our mood and behavior the following day. Sometimes they also leave us unable to get back to sleep due to the emotions and/or strangeness of the content. This exercise will help you make sense of those confusing dreams, help you handle the emotions caused by the dreams, and get back to sleep as soon as possible.

1. Get a notebook to use as a dream journal and keep the notebook and a pen by your bed. When you wake up from a distressing dream, immediately write down as much as you can remember about it. It doesn't matter if the information doesn't make sense or is strange. It's important to do this right away, because after even five minutes some details that might be important will be fading from your memory.

2. Once you've written down what you can remember about the dream, use the feelings below to describe how you feel and write as much as you can about how the dream affected each of these feelings in your dream journal.

a. Afraid (fearful, scared, panicky)

b. Sad (tearful, grieving, sorrowful)

c. Confused (upset, doubtful, perplexed, curious, puzzled)

d. Helpless (alone, paralyzed, vulnerable)

e. Angry (enraged, irritated, annoyed)

f. Ashamed (guilty, embarrassed)

g. Happy (satisfied, glad, grateful, triumphant)

h. Peaceful (calm, content)

i. Other emotions

3. For a dream that didn't have a clear ending, or had an ending that left you feeling bad, think of an ending that would make sense and leave you with positive emotions. Write your ending in your dream journal after you write about the feelings the dream caused.

4. Before you try to get back to sleep, visualize your new ending for the dream—like a movie in your mind's eye. Do this twice before going back to sleep.

5. The next day, read over the entry(ies) in your sleep journal and write down any ideas that come to mind about what the different parts of the dream might stand for. Don't worry if it seems weird or silly, just let your imagination go with this part. It may help to know that some psychologists think that in many dreams everything represents a different part of the life of the person having the dream—his or her options, desires, past actions, impulses, and so on. Your therapist may be able to help you figure this out, although there are no universal rules about what dreams mean. You might see books that say certain things appearing in a dream always have the same meaning, but that's not true. The meaning of anything in your dream depends on the unique mixture of your past life experiences, your personality, your present situation, and your plans, hopes, and worries about the future.

6. If you have a nightmare or unpleasant dream that you keep having over and over, it may be related to an important situation in your life. Sometimes you can find the connection by thinking about any real-life situations that cause you to feel the same emotions as the ones the dream does. There's a two-step process for dealing with this situation:

a. First, try the “write a new ending” method described above in items 3 and 4. If this works, it solves the problem of this dream.

b. If this doesn't work, look again at any life situations that make you feel the same way as the dream does, and think about whatever you are doing or plan to do to resolve that situation. Each night before you go to sleep, spend 5 to 10 minutes thinking about this plan and see whether your dreams change. If not, keep thinking about whether the dream is connected to any other situation in your life—past, present, or future.

Be sure to bring this handout and your sleep journal back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.

Avoiding and Coping with Nightmares

Goals of the Exercise

1. Eliminate distressing dreams.

2. Eliminate anxiety about falling asleep.

3. Restore consolidated and uninterrupted sleep.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Avoiding and Coping with Nightmares” activity is an alternative to the “What Are My Dreams Telling Me?” activity. Providing relief from nightmares for the veteran/ service member is essential for treating traumatic stress disorders and restoring sleep. Assist the veteran/service member in choosing a nightmare and changing the content of the nightmare to something that is less distressing. The veteran/service member may want to choose the most distressing dream for the first trial, but encourage him/her to choose a nightmare that is more manageable until he/she has some success with the technique. It is also important to review relaxation and breathing techniques with the veteran/service member as this technique can be stressful.

EXERCISE XX.B Avoiding and Coping with Nightmares

Nightmares can be a way for the mind to process and adjust to experiences in the first few days and weeks following a traumatic event. In order to process the negative emotions associated with a trauma the mind replays the event again and again to understand and make sense of it. This process happens when you are awake and when you are asleep. However, when you sleep your thoughts and dreams tend to take on a life of their own. They can develop into an ongoing loop and replay over and over again like a scratched record, and this can make it difficult or impossible for you to get to sleep or get a good night's rest. If this is going on the dreams are no longer useful to you. This exercise will help you break this loop and regain control over your nights.

1. First, make yourself comfortable by using relaxation and breathing exercises:

a. Diaphragmatic breathing—Breathe slowly and deeply from the diaphragm. You can tell when you're doing this correctly because your stomach will rise when you inhale rather than just your chest. Do this for five minutes.

b. Progressive muscle relaxation—Starting with one foot and lower leg, tense the muscles in that part of your body, hold them tensed for about ten seconds, then relax them completely and move on to the next muscle group. If you start with your left foot, the sequence would be: left foot and calf; right foot and calf; left thigh; right thigh; left hand and forearm; right hand and forearm; left upper arm; right upper arm; buttocks and lower torso; mid- and upper torso and shoulders; neck; jaw and face.

c. Pleasant visual imagery—If you've learned the “Safe and Peaceful Place” meditation exercise, this is a good time to use it. If not, just think of the most pleasant, peaceful, and relaxing place you can, and spend five minutes picturing it in your mind's eye.

2. Next, select a nightmare that rates about a “50” on the distress scale below.

No distress: 0

Low distress: 25

Moderate distress: 50

High distress: 75

Most extreme distress possible: 100 (panic attacks, crying, etc.)

3. Change the nightmare by “rewriting” it—any way you wish to create an alternate version of the dream that is less disturbing or not disturbing at all. (Don't run the nightmare in its distressing form through your mind while doing this.) Briefly describe the dream you have created here:

_____

_____

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4. Rehearse this new dream in your mind twice daily for 20 minutes each time until the original nightmare disappears. Please document the times you rehearse the new dream here:

Monday Rehearsal #1 _____ Rehearsal #2 _____
Tuesday Rehearsal #1 _____ Rehearsal #2 _____
Wednesday Rehearsal #1 _____ Rehearsal #2 _____
Thursday Rehearsal #1 _____ Rehearsal #2 _____
Friday Rehearsal #1 _____ Rehearsal #2 _____
Saturday Rehearsal #1 _____ Rehearsal #2 _____
Sunday Rehearsal #1 _____ Rehearsal #2 _____

5. Now repeat this process, except with a more disturbing dream. Again, rewrite it without dwelling on the unpleasant original form, and then document your version here:

_____

_____

_____

_____

6. Again, rehearse this new dream in your mind twice daily for 20 minutes each time until the original nightmare disappears. Please document the times you rehearse the new dream here:

Monday Rehearsal #1 _____ Rehearsal #2 _____
Tuesday Rehearsal #1 _____ Rehearsal #2 _____
Wednesday Rehearsal #1 _____ Rehearsal #2 _____
Thursday Rehearsal #1 _____ Rehearsal #2 _____
Friday Rehearsal #1 _____ Rehearsal #2 _____
Saturday Rehearsal #1 _____ Rehearsal #2 _____
Sunday Rehearsal #1 _____ Rehearsal #2 _____

7. Repeat the process for any other dreams you want to get rid of.

Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.