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Dream Analysis: Traumatic dreams and suicide risk

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Keywords: PTSD, transgender, nightmares, Holocaust survivors, dream analysis

Synopsis


Andrew, Cogan, Scholl, and Davis (2020) noted that transgender and other gender diverse individuals are at risk for suicide. The study investigated the connection between exposure to trauma, disturbance in sleep, and suicide risk in a sample consisting of 155 transgender and other gender diverse individuals. The frequency of nightmares was found to be a predictor of suicide risk, however, the severity of nightmares were not on their own linked to suicide risk. Several analyses of an exploratory nature were undertaken to examine the effects of exposure to trauma and PTSD symptoms severity on the relationship in the first analysis. In the second analysis, the severity of PTSD symptoms contributed in a significant way to suicide risk much more than nightmare severity and trauma exposure. The study results suggested that nightmare frequency may be instrumental in suicide risk more than that of trauma exposure and PTSD among transgender and gender diverse individuals.


In the second article about the testimonies of Holocaust survivors,Owczarski (2018) pointed out that the study was based upon former concentration camp survivor testimonies submitted to polish psychiatrist in 1973. The study emphasized the analysis of traumatic dreams of the survivors. Qualitative and quantitative analysis were used. The main focus of the study was to test the hypothesis grounded in Hartman's theory that posited that even dreams of a frightening nature can contain adaptive and healing potential. The hypothesis was confirmed. The researcher noted that the dreams concerning the camps were therapeutic in  nature in the sense that they allowed new material to be woven into the traumatic memories. Therefore the researcher concluded that repressive mechanisms support the coping process in terms of holocaust trauma


Contrasts


It is interesting to note, that the sample of the Holocaust survivors was smaller than that of the transgender sample. The transgender sample consisted of 155 participants . In the study, there was information about the positive emotions that pointed to that in the case of women 9% of positive emotions were found in the norm for women appear to be 18%. There were gender differences which pointed to 11% of women were angry in the camps in terms of the dream. In contrast to men in which they were 2% of the men who demonstrated anger in their dreams. The researcher compared the women's dreams to the men's . For example in the women's dream it appeared there were more familiar figures than in the men's dream. The researcher noted 35% and 30% respectively. The researcher noted that 12% of the women dreamt less often about friends than men. 18% of men dreamt about friends. The transgender study provided information that was different from that of the holocaust study.  Past research had established a connection between sleep disturbance and suicide risk.

 The existing research had been undertaken with mainly cisgender samples. As such, the researchers sought to further explore research using a transgender sample to investigate whether the connection among trauma, sleep disturbance and suicide risk would still be present in the transgender sub-population. In contrast, the holocaust study investigated the differences between men and women in terms of dream life. In the transgender study the researchers provided a hypothesis of an exploratory nature. The first hypothesis centered around past week nightmare frequency as a predictor of suicide risk and nightmare severity would predict suicide risk. The researchers also were seeking to explore the connection and contribution of nightmare frequency and severity when other variables such as PTSD as predictors. In the Holocaust study, in terms of the evaluation of dreams, gender differences as related to social interactions in the dreams of both men and women. 

Women were found to exhibit aggression more often in dreams than men. However, women were found to be more active in the sense of being three times more often the aggressors and dreams than men. Hartman (2001) pointed out some interesting ideas about nightmares. For example, the researcher stated that it is widely known by nightmare experts that dreams following trauma rarely reproduce the trauma as it actually occurred. The researcher explained that rather than reproduce the trauma as it occurred, instead new experiences were added that would tend to have a therapeutic effect.  As a relationship is created between the trauma and new material, the overwhelming emotions of trauma seem to subside and become integrated into the individual's life. Interestingly, in cases of severe trauma with more advanced PTSD symptoms, dreams seem to reproduce in vivid detail the past drama and as such are no longer weaving in new material. 

Hartman discussed and made a distinction between post traumatic nightmares and ordinary nightmares.  Traumatized individuals such as Holocaust survivors with PTSD, very rarely have dreams that reproduce the trauma without changes. Their dreams tend to add new material and new information that moves between the past and the present. Hartman termed this phenomenon as ordinary nightmares that have healing potential.

In the transgender study, suicide attempts among the general population is 5%. In contrast, the rate in transgender populations is between 30% and 81% and the researchers discussed explanations for this increase among transgender populations.  Previous research among the general population suggested the trauma exposure is connected to suicide risk and nightmares which in many cases follow exposure to a traumatic event that have been associated with suicidal thoughts, suicide attempt, and death by suicide.  The transgender populations experience a higher rate of traumatic events in comparison to the general population with 98% of transgender individuals having had a trumatic event in their lifetime. Therefore, 91% have reported multiple traumatic events. In addition, past research has indicated that disturbances with sleep, including falling and staying asleep and nightmares are common symptoms and individuals who have experienced a traumatic event.  Nightmares have been connected and associated with the development of PTSD and negative health outcomes as related to PTSD. The researcher emphasized that nightmares have a connection with an increase in suicide risk which was described as fivefold. In the transgender study, the researchers also use several assessments which provided information about which assessments are appropriate for measuring symptoms of PTSD. Among the assessments used was the life events checklist. This is an inventory which assessed for trauma exposure based on the DSM 5.diagnostic criteria. The researchers also used the trauma related nightmare survey to gather data concerning the content of the traumatic nightmares. The researchers also used the trauma related nightmare survey to gather data concerning the content of the dramatic nightmares. In addition, the researchers used the suicide behaviors questionnaire revised to assessed for suicidal ideation, behaviors, communication and the likelihood of future suicide attempts. The researcher noted that the results of the first regression supported the first hypothesis which stated that nightmare frequency was related to and a predictor of suicide risk. Further, the length of time the individual experiences nightmares has a connection to increased risk. Further,  nightmares that have been experienced for a greater period of time and with more frequency, result in sleep disturbance leading to higher suicide risk. In terms of the second regression, the researchers noted that it did not support the hypothesis that stated that nightmare severity would also predict suicide risk. 

In the holocaust study, The researcher noted that Hartman was not unique in observing positive healing effects of nightmares.  Dreams which contain traumatic aspects are actually being changed and linked with images that can be viewed as a way in which the dreamer enters a process of coping with the trauma.   Once the ordinary nightmare emerges after a long period of recurring traumatic dreams, the healing process begins and as such, the researcher referred to this as the healing nightmare. The researcher explained that it is the psyche's way of embracing healing. Other research that spoke to disguising other traumatic material in a dream as a positive sign that the dreamer is on their way to recovery.

Expansion on other research 


Lewis and Krippner (2016) spoke about imagery rehearsal therapy which appear to be similar to what the holocaust study described as adding new material to a traumatic dream. For example, the researchers explained that imagery rehearsal therapy addresses the nightmare in a direct way. The process includes exposure to nightmare content  in addition to rewriting aspects of the nightmare. The researchers pointed out that in several case studies this process has been found to be efficacious for individuals who suffer trauma as well as chronic nightmares. Imagery rehearsal therapy involves having the provider encourage the dreamer to write  a stressing dream but also to change any aspect of it that they want to. In the process the dreamers focus on comparing the original dream to the editor dream. As time goes on, the nightmare seems to evolve. As time goes on, dreaming seems to take on an adaptive function as the researcher noted through the exposure to less distressing content. This process allows the dreamer to self regulate and are such, The nightmare appears to have less impact on the dreamer. The researchers not only discussed rewriting the narrative of the nightmare but also using humor.By giving examples of how the Holocaust survivors integrated new material to their nightmare content, Lewis and Krippner (2016) noted that individuals that are diagnosed with PTSD experience chronic anxiety as a result of an increase in arousal that was absent before the traumatic  event. Further, nightmares as well as sleep disorders, irritability, and anger are very common symptoms. In the holocaust study, it was pointed out that the women in the study demonstrated more anger in their dreams than men. Further, the Holocaust study expanded upon the work of Lewis and Krippner (2016) by introducing the challenging and horrific experiences of holocaust survivors. Similarly, Lewis and Krippner (2016) described individuals with PTSD who are in hostile environments that include both imprisonment and torture and how they use behavior that is oriented toward survival .

The transgender study also expands upon the material in the work of Lewis and Krippner in the sense of giving an example of a population that has been victimized. The transgender study discusses the transgender population and individuals with gender diversity who have been victimized and to have a high incidence of suicide rates. Krippner and Lewis (2016) address trauma as what they described as an attack on the human mind that has a negative impact on ordinary functioning. The researchers speak about psychological trauma that leads to disorders and those disorders that appear not to heal as well as producing nightmares. The transgender study expands on Lewis and Krippner's work  in the sense that it gives an example of a population which is vulnerable and which can be thrust into a life-threatening event based upon the frequency of nightmares  

The Holocaust study expanded upon the ideas of Lewis and Krippner (2016) by speaking about and describing memory intrusion's that are characteristic of PTSD. The holocaust study researchers described recurring nightmares as memory intrusions among the Holocaust survivors. The nightmares were described metaphorically as a "broken record" frozen inside a groove." Therefore, the only way the broken record can play out, other material from memory may help to lessen the impact of the dreamer's sense of being overwhelmed by emotion. The holocaust study pointed to the fact that post traumatic trauma can shift overtime and actually become more adaptive.

Support


The articles support each other in the sense that each speaks of a vulnerable population who both face would appear to be insurmountable obstacles towards recovery. Both articles speak of interventions to use in order to alleviate nightmares. In the holocaust study, the researchers speak to how the presentation of new material woven into the traumatic dream can be helpful towards the dreamers coping. In the transgender study, the researchers encourage the identification of individuals who may can benefit from focused interventions for nightmares which in the end will help to decrease suicide risk. In the transgender study, the researchers encourage The use of assessments for identifying individuals who may be at risk for suicide. For example, the trauma related nightmare survey can be helpful in assessing for the presence, frequency, and severity nightmares in an individual.



Information to Use for Clinical Practice


The transgender study, focused upon the transgender and gender diverse individuals tendency towards having an increased risk for suicide. Further nightmare frequency was emphasized to be a significant predictor of suicide risk while nightmares severity was not. Therefore, this information would be critical in working with clients with PTSD who are part of the transgender and gender diverse populations. The information in the article about the various assessments that can be used to identify the most vulnerable individuals would be important to use part of the treatment. As the researchers noted, it would also be important to investigate the differences among nightmares and a variety of sleep disturbances such as insomnia to make a determination These also could contribute to a high prevalence of risk for suicide. The information in the holocaust study pertaining to an aspect which in genders hope witches as the researcher noted that traumatic dreams can also have therapeutic potential as the dreamers tend to incorporate new material into their traumatic memories. This process was termed "comeback dreams." The researcher described this process of the dreamer having an awareness that they've returned to the concentration camp for the second time having an adaptive effect upon the dreamer. Since perhaps it would be rare for a therapist to have a Holocaust survivor as a client, it is important to remember that any individual who has experienced severe trauma can benefit from understanding the healing potential of nightmares.  When new connections are made among the traumatic event and other new material, the emotions of the dreamer lessen the impact and become less overwhelming. As such,  the trauma is eventually integrated into the life of the dreamer. This process may not happen in cases of very severe trauma with highly developed PTSD. It is important to use this information and understand that dreams will continue to reproduce the precise traumatic event and there will be a point where the dreamer is no longer using new connections. As such, it would be critical to assess the dreamer to understand the severity of the PTSD and the trauma before encouraging the dreamer to make new connections.

In the holocaust study, the researcher admitted that the repression of nightmares as an approach might not be effective with all traumatized individuals. In the holocaust study, some of the dreamers dreamt of being back in the camp although the war was over and it had been five years since it had ended. The researcher noted that although a dream about still being at the camp can be characterized as a nightmare, the dreamer seems to strengthen their capacity to view their traumatic memories from another point of view. The nightmare itself that strengthens the dreamers capacity to do this.  Not all of these dreams of returning to the camps had a positive impact on the dreamer. However, the more the awareness of the dreamer is heightened when they have this type of dream where they return to the camps, the more impactful and adaptive the dream can become as the researcher noted. 

This type of heightened awareness can produce lucidity. However, very few of the holocaust survivors in the study demonstrated having the capacity towards having lucid dreams. Yet, the researcher noted that lucid dreaming can be used effectively in the treatment of nightmares. The researcher encouraged metacognitive experiences that would include awareness in the reflective sense, self-awareness, or self regulation which the researcher noted can be part of the dreaming state. As such, it would be important to explore the dreamers experience in order to identify if they've experienced these states.






References

Andrew, S. J., Cogan, C. M., Scholl, J. A., & Davis, J. L. (2020). Nightmares as a unique predictor of suicide risk in a transgender and gender diverse sample. Dreaming, 30(4), 329-337. https://doi-org.proxy1.calsouthern.edu/10.1037/drm0000151

 

Lewis, J. E. & Krippner, S. (Eds.)   (2016).   Working with dreams and PTSD nightmares: 14 approaches for psychotherapists and counselors.   Praeger. 

 

Owczarski, W. (2018). Adaptive nightmares of Holocaust survivors: The Auschwitz camp in the former inmates' dreams. Dreaming, 28(4), 287-302. https://doi-org.proxy1.calsouthern.edu/10.1037/drm0000086

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