Tuesday, March 12, 2013

NIGHTMARE REMEDIES: RESCRIPTING BAD DREAMS

Alan Siegel, Ph.D.


Copyrighted Excerpt from Dream Wisdom: Uncovering Life’s Answers in your Dreams
by Alan Siegel, Ph.D. (Berkeley: Celestial Arts, 2003)


During a crisis or after a traumatic event, it is important to know nightmares are more common and upsetting. We experience each nightmare as a traumatic event and for those who have experienced violence, a natural disaster, accident or other trauma, posttraumatic nightmares rub salt on our emotional wounds. Keep in mind that moderately upsetting nightmares may actually be a positive sign of normal coping but very graphic nightmares that are repetitive and unchanging may signal an emotional impasse.

Nightmare remedies are self-help techniques that can help adults and children break the spell of their bad dreams and use them for personal growth and creative inspiration. A simple method for transforming nightmares is to use the 4 R’s of nightmare relief. Reassurance, Rescripting, Rehearsal, and Resolution.

Reassurance is the first and most important step. This breaks the spell of the nightmare by giving emotional reassurance and for family members or children, physical comforting may help as well. Once you feel reassured and the nightmare’s reign of terror has been overthrown, you can relax, become curious about the nightmares meaning and message and begin to approach the dream in a more playful manner.

Knowing that occasional nightmares are normal and their frequency and intensity may increase during crises may also be reassuring. A key factor, especially for children, is not to dismiss or ignore the nightmare with a message that “it’s just a dream” or you should just ignore it. Nightmares, especially during a life crisis are very hard to ignore.
Reassurance paves the way for Rescripting the dream. Rescripting uses discussion, fantasy, writing, art, or drama to re-experience and revise different parts of the dream narrative with the goal of opening up new endings and directions. You can use techniques from the Experiential Dream Menu in Chapter 11 of Dream Wisdom, to transform and tame the most threatening interactions and moments in the nightmare. This can be as simple as experimenting with rewriting one or more new endings for the dream or may involve more elaborate free associations to link the conflicts in the nightmare to unresolved life issues.

The third R needed to implement a nightmare remedy is Rehearsal. This involves multiple forays and trials of rewriting and re-enacting the dream. If you are having nightmares about an auto accident or serious physical injury, imagining one new ending may only be the beginning. Depending on your creative inclinations, you may need to write out one or more new endings, sketch or paint the threatening elements in the dream or role play with a friend or with a psychotherapist or dream group. Creating new endings does not have to involve killing your dream adversary. The terrorist or robber or wild animal can be frozen or shackled. Walls, cages, force fields, or even magic wands can be made available as you rehearse dream solutions. Adults may need to loosen up their imagination but children take to this easily especially with adult guidance. And for children, non-violent strategies for subduing dream villains can model creative problem-solving strategies that do not necessarily emphasize violence.

Rehearsal is somewhat parallel to the phase of psychotherapy, called“working-through” which involves taking breakthrough insights and testing them out in a variety of ways with people and situations. When nightmares are extremely painful or repetitive or related to a profound trauma, rescripting and rehearsing dream solutions may need to be repeated before the nightmares subside. It is important to keep in mind that conjuring up one new fantasy ending for a dream is not going to solve a deep problem that may be causing the nightmares. However, even if dream rehearsals must be repeated for people who are suffering more severe trauma, even initial efforts at rescripting may in some cases, dramatically reduce the incidence of posttraumatic nightmares.

The final Nightmare Remedy “R” is Resolution. Discussion and various trials of rescripting and rehearsing solutions usually trigger insights about what life issues are causing the nightmares. At this point, the dreamer on her own or with the help of a friend or psychotherapist is ready to resolve the nightmare. Resolution occurs when the dreamer brainstorms and identifies behaviors they can further examine or try to change. Examples of resolution would be Lisa’s work-related nightmares series in Chapter 6, of Dream Wisdom, which included the dream, ‘Too Many Chefs Spoil the Stew”. After rescripting the dream, she realized, she had denied her assertive side and was being taken advantage of by the employees in her restaurant. After rehearsing various dream assertiveness strategies for rescripting the attacks of her wayward employees, she made a series of changes that led to exerting more clear authority at work and being more aware of her tendency to deny her assertive side.

We do not have to suffer nightmares in silence. Using the menu of techniques in this section and chapter 11 of Dream Wisdom, you can detoxify your nightmares, and use them as a source of insight and personal growth. In more acute situations, resolving nightmares can create breakthrough in dealing with the aftermath of a traumatic situation.


WHEN TO SEEK HELP FOR CHILDREN’S NIGHTMARES


Whereas moderate nightmare activity may be a potentially healthy sign that the unconscious mind is actively coping with stress and change, frequent nightmares indicate unresolved conflicts that are overwhelming your child. When children’s nightmares persist, when their content is consistently violent or disturbing, and when the upsetting conflicts in the dreams never seem to change or even achieve partial resolution, it may be time to seek further help from a mental health specialist or pediatrician. Especially if there is no obvious stress in your child’s life, repetitive nightmares could also be caused by a reaction to drugs or a physical condition, so it is advisable to consult a physician to rule out medical causes when nightmares do not appear to have a psychological origin.

A further issue to consider is whether your child may be suffering from a sleep disorder. Many parents may confuse sleep disorders like sleepwalking and talking with nightmares which are more psychological in origin. Sleep disorders may or may not be accompanied by nightmares and are generally organic in origin. They are surprisingly common affecting over 15% of the United States population with 95% of all cases going undiagnosed. The International Classification of Sleep Disorders published in 1990
10, lists 84 conditions that interfere with sleep including Primary Snoring, Jet Lag, Restless Leg Syndrome, Narcolepsy and Sleep Apnea. Many sleep disorders such as Jet Lag will go away on their own. Others such as various forms of insomnia may reduce children’s ability to learn, lower their resistance to disease, and increase accident-proneness. Some sleep disorders may even be life-threatening such as sleep apnea. If you suspect that your child is having a sleep disorder11, speak to your pediatrician to determine if he or she needs to consult a board certified sleep specialist or to be evaluated in a sleep center12 13.

The current diagnostic manual of the American Psychiatric Association (DSM-IV) includes Nightmare Disorder as an officially recognized affliction of both children and adults. Those who suffer from this disorder have “extremely frightening dreams, usually involving threats to survival, security, or self-esteem” that “generally occur during the second half of the sleep period,”and may cause “significant distress or impairment in social, occupational, or other important areas of functioning.”

Repetitive nightmares are often accompanied by other symptoms especially fears of going to sleep, anxieties or phobias. Increased nightmares can usually be linked to a recognizable stress in the child’s life such as absence or loss of a parent, suffering abuse or violence, marital or custody disputes in the family, social or academic difficulties at school, such as being teased or having an undiagnosed learning or attention problem.

Nightmares are more often like a vaccine than a poison. A vaccination infects us with a minute dose of a disease that mobilizes our antibodies and makes us more resistant to the virulence of smallpox or polio. As distressing as nightmares can be, they offer powerful information about issues that are distressing your child. When children share their nightmares and receive reassurance from their parents, they feel the emotional sting of the dream, but also begin the process of strengthening their psychological defenses and facing their fears with more resilience.


Gradually, a parent’s empathic response to their child’s nightmares can break the cycle of bad dreams and transform intensely negative experiences into triumphs of assertiveness and collaborative family problem-solving.




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