Post-Traumatic Stress Disorder and Lucid Dreaming Therapy

Post-Traumatic Stress cark and pel gauze-like ambition TherapyPost-Traumatic Stress unhealthiness ( government agencyhurttic stress disorder) has seen a steep incline in recent years, affecting over 1 adult in every 12 (National Comorbidity Survey reproductive memory NCS-R, 2001-2003). Per the Ameri tummy Psychiatric Association, it is defined as a psychiatric derangement that can occur in people who take away regardd or witnessed a traumatic event such(prenominal) as a inborn disaster, a serious accident, a terrorist act, war/combat, rape or both(prenominal)(prenominal) other(a)wise violent personal usurpation (APA, 2015). An adult diagnosed with posttraumatic stress disorder can arguably obtain normality in behaviour and mindset through respective(a) forms of psychotherapy and medication, and resultantly recover from the disorder. plain stargaze Therapy (LDT) is becoming an increasingly bighearted influence in the format of ikon therapy, which begs the question , to what extent can Lucid woolgather be hard-hitting in treating the identifying characteristics of posttraumatic stress disorder?Exposure Therapy is a format of behavioural therapy in which a affected role re-enters the setting in which they experience the initial trauma, whether it be virtuall(a)y, imaginatively or physically, and attempts to confront the worrisome itemor (APA, Division 12). Exposure therapy is advertised as a intercession comp angiotensin converting enzyment range for several problems, including Phobias, Social Anxiety Disorder and posttraumatic stress disorder. However, the deflection with the latter is the inability to physically recreate the event in the train manner that it originally occurred, with all smells, sounds and emotions originally experienced. The goal of Lucid Dreaming Therapy (LDT) is to reduce the detriment ca utilise as a result of posttraumatic stress disorder in order to en equal to(p) a deplor equal adult to best government agenc y independently and successfully in various environments (Green McCreery, 1994 Halliday, 1988 LaBerge, 1985 LaBerge Rheingold, 1990 Tholey, 1988). LDT is most successful in combination with ahead of time intervention. Treatment closely later a traumatic event allows for a greater possibility to alleviate ache from set up such as nightm argons and depression.Characterizing Description of posttraumatic stress disorderposttraumatic stress disorder is classified as a trauma and stressor related psychiatric disorder, largely due to quad common ingests that appear from angiotensin-converting enzyme-third months to years after the occurrence of a traumatic event. These characteristics ar intrusive memories, stave offance, negatively charged changes in sight and mood, and changes in emotional reactions (DSM-IV-TR to DSM-5). The diagnostic features of PTSD best described in the diagnostic and Statistical Manual of Mental Disorders DSM-5. At least eight of the criteria moldine ss be present for the diagnosis of PTSD. Of these eight, additional requirements exist in apiece argona. Exposure to death, violence or speck is virtuoso delineate feature of PTSD, referred to as stressor. This can be marked through direct exposure, witnessing the trauma, encyclopedism that a relative or close friend was exposed to a trauma or Indirect exposure to aversive details of the trauma. A patient role must have iodin of these social criterions to be marked as a patient of PTSD.Symptoms of intrusion are other psychiatric hospital of PTSD. A persistently recurring format of reliving the trauma is characteristic. such signals include recurrent or involuntary and intrusive memories, traumatic incubuss, dissociative reactions such as flashbacks ranging on a continuum of brief episodes to loss of consciousness, intemperate or prolonged excruciation after exposure to traumatic reminded, as thoroughly as marked physiological reactivity after exposure to trauma-relate d stimuli.Persistent effortful avoidance of distressing trauma-related stimuli after the event is a nonher core to PTSD. This can be marked through trauma-related thoughts or feelings in addition or replacement to trauma-related external reminders (e.g. people, places, objects or activities).Negative alterations in cognition are often a bi-product of PTSD and therefore a unwrap factor in diagnosis. These alterations include dissociative amnesia in relation to the backbone features of the traumatic event, persistent or distorted negative beliefs and expectations about oneself or the world, persistent blame of oneself or others for causing the traumatic event or for resulting consequences, persistent negative trauma-related emotions, markedly diminished engross in pre-traumatic significant activities, a sense of alienation/detachment from others, and a persistent inability to experience positive emotions. A patient must have at least two of these symptoms to be diagnosed with PTSD. There are many an(prenominal) well-known associated features and disorders with PTSD. Insomnia, ranging from mild to pro strand, is prevalent in most movements. Irritability, aggression, suicidal actions or reckless(prenominal)ness are behavioural symptoms that may accompany PTSD. Additionally, hypervigilance and an overstated startle response, sometimes accompanied by problems in concentration are slips of alterations in arousal and reactivity that may have begun or decline after the traumatic event. Two of these alterations are necessary for diagnosis of PTSD. former(a) factors such as duration/persistence of symptoms, functional impairment and balk of exclusion (verification that disturbance is non due to medication, substance use, or other illness) are key in the diagnosis of PTSD. By definition, the onset of PTSD requires that the given symptoms occur for a minimum of a month. Although to a relatively minor extent, most symptoms are present directly after the trauma an d will continuously aim throughout time. PTSD is two to third times more(prenominal) prevalent in females than to males. An experience of sexual assault or child sexual abuse is more likely amongst women in comparison to accidents, physical assault, combat, disaster or witness to death/injury being the likely trauma for men. The median repress of Post-Traumatic Stress Disorder sick persons is 7 to 8 per coke individuals, with account ranges ranging from 7 20 per 100 individuals, the latter being combat related. The most recent statistic shows up to 8 in 100 individuals may be diagnosed with autism (DSM-V-TR). As the direct/chemical substance cause of PTSD is debatcapable, the reason for recent increase is, while speculative, soon unknown.Methods of Lucid Dreaming Therapy (LDT)Lucid Dreaming Therapy (LDT) is an upcoming format of intervention that has been specifically researched for application in relation to the treatment of PTSD. Lucid Dreaming is defined as the state in which an individual is aware that they are conceive of and subsequently obtain sustain over their woolgathers. The phenomenon of lucid envisage dates back centuries and quite possibly millennia, with reports of its use dating back to the 8th century, in the form of what was known to be Dream Yoga. With scientific hitch of the phenomenon in the late 20th Century, healing(p) possibilities began to be brought to light.Lucid Dreaming Treatment (LDT) arose from this idea as an alternative cognitive-restructuring technique, barely precisely a small amount of research has been conducted on the topic, composed mainly of eccentric person studies (Abramovitch, 1995 Brylowski, 1990 Spoormaker train den Bout, 2006 Spoormaker, new wave den Bout, Meijer, 2003 Zadra Pihl, 1997).Nightmares are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) to be extremely stir and anxiety-provoking dreams which awaken the idealist, followed by full alertness (APA , 2000). Although this is the current definition used as a diagnostic criterion, harmonize to DSM-IV-TR, and in this essay, it should be mentioned that some have challenged this definition (Spoormaker, Schredl, van den Bout, 2005 Zadra, Pilon, Donderi, 2006).In the adult population, as many as 70 % of individuals report at least an occasional(prenominal) incubus, and 2-5% suffer from recurrent nightmares (Lancee, Spoormaker, Krakow, van den Bout, 2008). Suffering from recurrent nightmares causes distress in argus-eyed life story and can result in both occupational and social dysfunction. The timidity and anxiety which the nightmare provokes linger when the dreamer awakens from it, which may prevent the individual from returning to sleep due to the worship of re-experience.It has been suggested that by becoming lucid during the nightmare, the dreamer can take control of the threatening perspective and change the course of the nightmare, thus possibly alleviating feelings of charge and anxiety. This could possibly result in trim nightmare frequency, relieving the nightmare sufferer from its negative effects both in sleep and argus-eyed life (Gackenbach Bosveld, 1989 Gavie Revonsuo, 2010 Green McCreery, 1994 Halliday, 1988 LaBerge, 1985 LaBerge Rheingold, 1990 Tholey, 1988).In LDT, the participants describe their nightmare and are then introduced to the opinion of LD, the possibility to become conscious while dreaming and to be able to alter the sum at will. The participants are then taught different LD inductive reasoning techniques, such as choosing a recurrent cue within their dreams to be a signal of being in the dream state, or quizzical the nature of reality several times during the day, asking themselves Am I dreaming? The participants then choose an alternative, more positive scenario of the nightmare, focusing on the subject they wish to alter whilst lucid (Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997).A Pi lot Study conducted by the Department of Clinical Psychology of Utrecht University in the Netherlands aimed to evaluate the effects of LDT on recurrent nightmares which is an identifying characteristic of PTSD. The participants of the analyze include 23 individuals (167, Female Male) who have recurrent episodes of nightmares. The requirement from the participants of the study was to englut out a questionnaire regarding their sleep and Diagnostic Traits of PTSD. These individuals were randomly divided into 3 groups 8 participants received one 2-hour individual LDT academic session, 8 participants received one 2-hour group LDT session, and 7 participants were placed on the waiting list. LDT consisted of exposure, mastery, and lucid dreaming exercises to train their mind to become more self aware. Participants then fill up out the same questionnaires 12 weeks after the intervention as a finish. It was found that by the follow-up, nightmare frequency of both treatment groups had sh own a decrease. There were no significant changes observed in sleep flavour and severity of posttraumatic stress disorder symptom. This led to the conclusion that while LDT seems effectual in cut down the frequency of nightmares, the primary therapeutic components of exposure, mastery, or lucidness remain unclear.The results of utilizing LD as treatment are consistent, indicating that LDT is effective for reducing nightmare frequency (Abramovitch, 1995 Brylowski, 1990 Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997). A one-year follow-up showed that quatern out of five participants, who prior to the treatment suffered from nightmares once every a few(prenominal) days, went down to once every few months or no long-dated had any nightmares (Zadra Pihl). In another study the treatment consisted of one two-hour session either individually, in group or, and as the control condition, being on a waiting list where no treatment was received. The participants had suffered from nightmares for over one year, at least once a week. The 12 week follow-up showed that nightmare frequency decreased in both treatment conditions, which was not the eggshell for the control group (Spoormaker van den Bout). For some participants LDT was in any case effective in reducing non-recurrent nightmares with differing meats (Zadra Pihl). Some of the participant had in addition subjectively reported slightly improved sleep quality after LDT (Spoormaker et al.) and that dream lucidity resulted in higher positive psychological elements which were similarly reflected in argus-eyed life (Zadra Pihl). Similar effects have been reported by Brylowski and Abramovitch.The studies showed that while nightmare frequency was reduced following LDT, not all of the participants dis assembleed in becoming lucid and to lucidly alter the content of the dream. One of the reasons attributed to this being the mere feeling of control which is necessary to LDT. beingness ab le to master the nightmare and not being its victim seems to play an every bit vital role as the actual altering of the content (Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997).Experiencing a traumatic event of extremely excite and life-threatening character may, for some people, develop into Posttraumatic Stress Disorder (PTSD). PTSD is a severe anxiety disorder in which the symptoms are pile up under three clusters intrusive/re-experiencing symptoms, avoidance symptoms and hyper arousal symptoms. Those suffering from PTSD endure highly disturbing recollections of the event. They disclose heightened sensitivity towards both internal and external stimuli which resemble or in any course symbolize some aspect of the original event. When confronted with similar symbols or conditions, they experience emotional numbness and sleep difficulties.The individuals self defence mechanism leads them to avoid all such stimuli which may remind them of the event. Hence those suffering from PTSD often experience constant conflicts in interpersonal relationships which can be attributed to heightened sensitivity as a result of PTSD. It is not uncommon for them to display recurring avoidance patterns in occupational sites which may remind them of the traumatic event. (APA, 2000).In addition to heightened sensitivity and severe anxiety posttraumatic nightmares that play back or indirectly symbolize, the original traumatizing event constitute the most frequent symptom in PTSD. (APA, 2000). It has been estimated that up to 60-80% of PTSD patients suffer from posttraumatic nightmares (Spoormaker, 2008). However, research has shown that treating PTSD does not necessarily reduce nightmare frequency (Spoormaker Spoormaker Montgomery, 2008). In contrast, Imagery story Therapy (IRT), a treatment focusing on alleviating nightmare frequency in PTSD in any case reduces cosmopolitan PTSD symptom severity (Krakow Moore, 2007). query has also shown that nig htmares and disturbed sleep may be a encounter factor for developing and maintaining PTSD (Mellman Hipolito, 2006). Due to these findings, Spoormaker (2008) and Spoormaker and Montgomery (2008) stated that posttraumatic nightmares ought not to be viewed as a secondary symptom but quite as a central characteristic in the advancement of post traumatic stress disorder. Their series of research, studies and findings led them to infer that posttraumatic nightmares might develop into a disorder of its own and therefore demands specific treatment.LDT is effective in reducing the frequency of recurrent nightmares (Abramovitch, 1995 Brylowski, 1990 Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997), and thus it has been suggested that LDT could be a valuable supplement in the treatment of PTSD, focusing on decreasing the frequency of posttraumatic nightmares. As posttraumatic nightmares are a nocturnal replay of the original traumatic event, the patient is reminded of the trauma every time they dream about it. A reduction in the frequency of post traumatic nightmares would lead to an abatement of aid and anxiety due to decreased instances of number of occurrences in a given time frame. In addition to this, as anticipated by Spoormaker (2008) and Spoormaker and Montgomery (2008), posttraumatic nightmares not totally enhance but also prolong the severity of PTSD. As such, LDT could work as a supplement to already existing treatment of PTSD and reduce nightmare frequency. moreovermore, LDT offers the patient the opportunity to alter the content of the dream to a less fearfulnesssome dream, which could lead to reducing the feelings of fear and anxiety within the dream. If LDT is effective in both reducing nightmare frequency and the cold feelings of fear and anxiety, it might also be effective in decreasing the fear and anxiety associated with the original trauma during wakefulness, which in turn could lead to a reduction in general PTSD symp tom severity.While this manageable effectiveness of LDT on PTSD was proposed by Green and McCreery (1994) in the early days of LD research and recently by Gavie and Revonsuo (2010), there has only been one study where researchers attempted to treat PTSD patients with LDT (Spoormaker van den Bout, 2006). They found that nightmare frequency was significantly reduced in subjects receiving LDT, but the study did not reveal any significant reduction in general PTSD symptom severity, which the authors proposed might have been due to the low service line for PTSD symptom severity in the studied population. Moreover, the study only included one participant out of 23 who was actually diagnosed with PTSD (Spoormaker van den Bout). Gavie and Revonsuo were adamant that no conclusions can be make based on this single study and encouraged forthcoming researchers to wonder the effect of LDT on PTSD nightmares and other PTSD symptoms with larger groups of diagnosed PTSD patients and longer luc idity interventions. idolise and Control Two Key Components for LDTFear is a main component of nightmares, experienced both during sleep in relation to the nightmare content and during wakefulness, as suffering from recurrent nightmares can lead to fear of going to sleep due to the risk of re-experiencing the nightmare. Fear also represents one of the key emotions during the course of PTSD (APA, 2000). In PTSD, fear is not only related to the extreme fright which was experienced during the occurrence of the traumatizing event, but also refers to the massive feeling of fear elicited when the patient encounters associable stimuli, which often serve as reminders of the original event. Posttraumatic nightmares largely replicate the original event, meaning every time the nightmare occurs, the patient re-lives the trauma and its accompanied fear (Gavie Revonsuo, 2010).Although LDT has been shown to be effective in reducing recurrent nightmares, not all participants succeeded in becomin g lucid and able to lucidly alter the content of the nightmare. This has been suggested do be due to the fact that the feeling of control, following from the mere knowledge of the possibility to master the nightmare, is equally as important as the actual altering of the content (Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997). As such, control might constitute a key component of LDT, both in respect to lucidly to control the content of the nightmare and alter the course of the dream, and to the feeling of control brought by the thought that the fear both during the dream and during wakefulness is something that can be overcome. In this sense, LDT might prove to be effective not only for patients suffering from nightmares and reducing nightmare frequency, but also for patients suffering from disorders characterised by fear, pass them the possibility to control and reduce the level of fear they experience.In one case study, a 35-year-old woman diagnosed with Borderline Personality Disorder (BPD) and study depression complained about frequent nightmares. She suffered from one to four nightmares per week, from which her self-confidence and pledge felt threatened. She did not suffer from recurrent nightmares, but her nightmares did contain a recurrent theme, relating to the physical and mental abuse she experienced by her incur as a child, and husband as an adult. These nightmares were so intense that she had difficulties in separating her experiences in them from her experiences in reality, and sometimes spoke of them as if they were real events (Brylowski, 1990).The patient was introduced to the phenomenon of LD and was instructed to keep a dream journal, which she was to take with her to therapy each week. She was also told to perpetrate an LD induction technique every night in order to produce how to become lucid during the dream. The appearance of her father or husband in the nightmare was chosen as a dream cue, used as an indic ator to remind her that she was just dreaming. Upon recognising that she was dreaming, she was to use the realisation as a reminder that she was safely lying in bed and there was nix to fear (Brylowski, 1990).During a six-month period, which included 24 sessions with her therapist, the patient experienced three lucid dreams and was able to alter the course of the nightmare in all three cases. Using LDT resulted in reduced nightmare frequency, intensity and distress, which provided her with a sense of mastery in relation to her emotions and responses to nightmares.Following these results, her therapist suggested that these abilities and attitudes could be used in waking life when dealing with similar problems. So, whenever she was approach with a stirred emotion or a difficult situation in waking life, she was able to remind herself of how she had controlled a similar situation in the dream state. In turn, she now had the capacity to deal with the waking situation just as she had w hile (lucid) dreaming (Brylowski, 1990). As a result, LDT provided her with a sense of mastery in relation to her emotions and responses to nightmares as well as her waking life, which then resulted in entering into psychotherapy.What Green and McCreery (1994) pass by up forward, is that LD provides us with the experience of achieving control over a mental aspect, in this case distressing nightmares. They argued that gaining control over one might, in turn, have a generalised therapeutic effect. In the case study, Brylowski (1990) showed how LDT not only reduced nightmare frequency and distress, but also how engaging in LDT could extend into managing situations waking life.LDT provided the patient with the experience of mastering a imposing situation within a nightmare, which, prior to the treatment, had affected her to the point where she could not differentiate nightmares from waking events.After the treatment the patient expressed increase self-confidence, knowing that she now possessed the capacity to make changes in other waking circumstances as well.Brylowski (1990) initated the notion that, Nightmares can occur across diagnostic syndromes. According to DSM-IV-TR, nightmares can occur frequently during the course of many psychological disorders without there being a specific diagnostic symptom, for example as a part of Personality Disorders, Anxiety Disorders, Mood Disorders and schizophrenia (APA, 2000). Brylowski concluded lucid dreaming worked well for this patient as it motivate her to start and stay in therapy. He suggested that LD as a therapeutic tool ought to be considered not only for treating nightmares, but also in the treatment of personality disorders.Although diagnosed with BPD, the patient also showed symptoms related to PTSD, i.e. nightmares which directly or symbolically represented a traumatic event (history of abuse) and depression which, according to DSM-IV-TR, is highly associated with PTSD (APA, 2000). On the basis of this fact alone, it is premature to draw any conclusions on the effect of LDT on personality disorders. However, engaging in LDT did have a general therapeutic effect in this case study, and as such, LDT could be valuable as a supplement in the treatment of BPD and possibly even other personality disorders. Overall, more studies are needed to but check over the possible general therapeutic regard as of gaining control over fear and anxiety using LDT, both in relation to recurrent nightmares, and to other psychological disorders such as PTSD and personality disorders.The current studies investigating the potential therapeutic value of LD in reducing recurrent nightmares have shown promising results, where engaging in Lucid Dreaming Treatment (LDT) has resulted in decreased nightmare frequency (Abramovitch, 1995 Brylowski, 1990 Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997), slightly increased subjective sleep quality (Spoormaker et al.) and reduced nightmare inte nsity and distress (Brylowski). As such, it has been suggested across these studies that LDT might be effective in reducing posttraumatic nightmares in PTSD (Gavie Revonsuo, 2010 Green McCreery, 1994). both time a nightmare occurs, the patient experiences the trauma and extreme fear associated with it. Therefore, there is the possibility that relieving the posttraumatic nightmare could, in turn, reduce general PTSD symptom severity (Gavie Revonsuo). With larger groups of diagnosed PTSD patients and longer lucidity interventions, future research could study the effect of LDT on posttraumatic nightmares.As examined, one case study showed that attitudes and skills learned through LDT can be transferred and applied to waking life situations (Brylowski, 1990). This could be an indication that LDT has the potential to work beyond the more specific focus of alleviating nightmares. Although nightmare frequency was reduced, not all of the patients were able to reach lucidity and alter th e course of events in their nightmare (Spoormaker van den Bout, 2006 Spoormaker et al., 2003 Zadra Pihl, 1997). On the basis of this, one possible and important key component of LDT could be that of control. In the case of Phobic patients, they were found to be less likely to believe in having control over events (Leung Heimberg, 1996). Considering lucid dreamers tend to believe in their own control over waking situations to a higher degree than non-lucid dreamers (Blagrove Hartnell, 2000 Blagrove Tucker, 1994), it shows that control could be one of the key elements of LDT and that LDT could be a valuable supplement in the treatment of phobia.Further and more extensive research is required in order to investigate the underlying functioning and other effects of LDT more deeply. There is also a gap in the research, where an opportunity exists to compare LDT to other cognitive-restructuring techniques, such as Imagery Rehearsal Therapy (IRT) and exposure therapy.In order to furthe r explore the effect of LDT, longer LD induction technique practices and more intense lucidity interventions are needed for LDT to be applicable in the eliminate patient population. As seen in previous studies, there is the potential for this to sustain recurrent nightmare sufferers, PTSD and phobias, larger groups of nightmare sufferers, diagnosed PTSD and neurotic patients. There is still untapped potential for the utilisation of LD as a therapeutic tool and supplement in the treatment of these symptoms, which needs to be studied in-depth.