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Dream anxiety disorder (recurring nightmares). Definition, incidence, treatment, causes, role of therapist.... More...
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Paper Abstract:
Dream anxiety disorder (recurring nightmares). Definition, incidence, treatment, causes, role of therapist.

Paper Introduction:
This paper will discuss nightmares as an abnormal behavior, using the guidelines provided in the American Psychiatric Association's Diagnostic and Statistical Manual of mental Disorders, third edition, revised (DSM-III-R). According to the classifications in DSM-III-R, there are three categories of "parasomnias," or abnormal behaviors during sleep. These are sleepwalking, sleep terror, and dream anxiety disorder (recurring nightmares). In dream anxiety disorder, the patient has frequent nightmares which generally present "threats to survival, security, or self-esteem" (APA, 1987, p. 308). These nightmares usually occur toward the end of the sleep cycle, when the patient is engaged in rapid-eye-movement (REM) sleep (APA, 1987, p. 308). An important feature of dream anxiety disorder is the fact that the patient usually becomes quickly oriented upon awakening and

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Recurring nightmareshave also been attributed to such causes as the use of medications as wellas withdrawal from alcohol or drugs (Erman, 1987, pp. (1983). 67 ). In such cases, psychotherapy combinedwith a consideration of safety measures for the patient generally results"in a favorable outcome" (Vela-Bueno, Soldatos, & Julius, 1987, p. Diagnostic andStatistical Manual of Mental Disorders, III-R. Sleepterror disorder usually occurs at an earlier period of sleep and patientsawakening as a result of it are usually "unresponsive to efforts of othersto comfort him or her until the agitation and confusion subside" (APA,1987, p. However,the DSM-III-R points out that most cases of dream anxiety disorder can berelated to "a major stressful life event" (p. Thus, itcan again be seen that a connection exists between traumatic events and theonset of nightmare disorder. 3 8). 178). 469). References American Psychiatric Association. Halliday, G. 96). Inseverely traumatized children and most adults, however, a more stringentapproach to treatment is required. Life-long nightmares: An eclectic treatmentapproach. Although the nightmares associated with dream anxietydisorder may be severe, it can be seen that the prognosis for treatment ofthis disorder is good. In this regard, Shear and Kundrat(1987) have described an "integrative-process approach" in which thetherapist works with the patient in order to arrive at a meaningfulinterpretation of the recurring nightmares. R., & Julius, D. 223). An important feature of dream anxiety disorderis the fact that the patient usually becomes quickly oriented uponawakening and has a vivid memory of the nightmare which has just takenplace (APA, 1987, p. The most important aspect of such treatmentinvolves the therapist helping the patient to deal with repressed emotions,thus paving the way toward a better understanding of the trauma causing thenightmares. Although both relate to the occurrence of repeated nightmares, it canbe seen that dream anxiety disorder is different in many ways from theparasomnia behavior known as sleep terror disorder. In adulthood, "it appears that severe nightmares serve as anemotional release for individuals who harbor resentment and fear hostilityfrom significant others" (Vela-Bueno, Soldatos, & Julius, 1987, p. Thus, thebest treatment for such patients is an approach which simply helps both thechildren and their parents to cope with the nightmares until they disappearof their own accord (VelaBueno, Soldatos, & Julius, 1987, p. Dream anxiety attacks (nightmares). 467).Dream anxiety disorder in adults generally requires psychiatric treatmentin order for it to be effectively overcome. (1987). In this way, the patient may arrive at a point where there isbetter self-control as well as a better understanding of the relationshipbetween trauma and nightmares. & Kundrat, S. Therapy for prophecy nightmares. Perhaps the most important element in successful treatment of dreamanxiety disorder is the attitude of the therapist. 3 8). 62-63). It is indicated in the DSM-III-R that dream anxiety disorder is morecommon in younger people than it is in older people. J. As noted, dream anxietydisorder in children is often the result of normal development. Vela-Bueno, A., Soldatos, C. The best method for the treatment of dream anxietydisorder appears to be one which takes an "eclectic approach" (Gorton,1988). Hartmann, E. The nightmare: The Psychology and biology ofterrifying dreams. L. 96). (1987). According to the classifications in DSM-III-R, there are threecategories of "parasomnias," or abnormal behaviors during sleep. .may be as important as the specific intervention" (Halliday, 1987, p. (1987).Parasomnias: Sleepwalking, night terrors, and nightmares. 311). New York: Basic Books. PsychiatricAnnals, 17(7), 465-469.----------------------- 1 Journal ofContemporary Psychotherapy, 17(3), 217-224. 672). For example,heredity may play an important part in causing the disorder because studieshave shown "a significantly higher incidence of nightmares among familymembers of nightmare sufferers than among the families of those with vividdreams or ordinary dreams" (Erman, 1987, p. This approach is effective inhelping patients see "choices and capacities to work on outgrowing thedisturbing dream and choices and resistance not to do so" (Shear & Kundrat,1987, p. In dream anxiety disorder, the patient has frequentnightmares which generally present "threats to survival, security, or self-esteem" (APA, 1987, p. . K. 11). The essence of suchtreatment is to help the patient overcome certain inner fears andhostilities. Washington, DC: Author. For example, Evans (1983) has notedthat approximately 9 percent of women experience nightmares often and 13percent of women experience them never, whereas approximately 4 percent ofmen experience nightmares often and 22 percent of men experience them never(p. In order for the patient to arrive at a better understanding of the selfand a better ability in coping with repressed emotions, the therapy shouldbe "an insight-oriented one with exploration of intrapsychic conflicts thatmay underlie the chronic complaint of nightmares" (Vela-Bueno, Soldatos, &Julius, 1987, p. Another study has shown a directlink between dream anxiety disorder and trauma in the case of sexuallyabused teenage girls. (1988). 61 ). In addition, there must be a meaningful rapportbetween the therapist and the patient. Hefez, A., Metz, L., & Lavie, P. Studies conducted by independentresearchers have supported this fact. For this reason, young patients suffering from the disorder oftenoutgrow it without requiring extensive treatment or therapy. Medications have been used in the treatment of nightmare disorder;however, the results of such treatment have been described as "uncertain"(Erman, 1987, p. Shear, H. 468). Researchers have arrived at a number of possible causes for the onsetof dream anxiety disorder in both children and adults. (1984). 671). (1987). This paper will discuss nightmares as an abnormal behavior, using theguidelines provided in the American Psychiatric Association's Diagnosticand Statistical Manual of mental Disorders, third edition, revised (DSM-III-R). Gorton, G. Such understanding, in turn, paves the way toward better self-understanding and self-control, states of mind which contribute strongly tothe patient's ability to overcome the necessity of such nightmares in hisor her life. Thus, it can be seen thata clear link exists between the occurrence of traumatic events and theonset of frequent, intense nightmares. (1987). American Journal ofPsychiatry, 144(3), 344-347. Long-term effects ofextreme situational stress on sleep and dreaming. With sleepterror, the patient usually does not remember the nightmare, but "sometimesremembers feeling crushed or suffocated" (Hartmann, 1984, p. 468). New York: Viking. These researchers analyzed the sleep anddream patterns of eleven patients who had survived traumatic events rangingfrom combat to terrorism to sea disasters. All of these traumatizedindividuals experienced nightmare disorder to one degree or another.However, the researchers noted that nightmares were more likely to occuramong the patients who had experienced their traumas more recently in thepast (Hefez, Metz, & Lavie, 1987, pp. In sleep terror, thepatient often wakes up screaming or in a state of panic. 31 ). The combination of thesetechniques helped the patient to better understand herself and therebyincreased her capability for dealing with the traumatic events which hadcaused the onset of nightmare disorder in the first place. Psychiatric Journal of the University of Ottawa, 12(2), 93-97. In terms of treatment, different approaches must be taken dependingupon whether the patient is a child or an adult. Providing conditions to helpclients outgrow disturbing dreams. 346-347). 366). This study, by Garfield (1987), found that the mostcommon dream theme among such abused girls was that of "being chased orattacked" (p. 3 9). 3 9). (1987). The relationship between traumatic events and nightmares was studiedby Hefez, Metz, and Lavie (1987). 67 -671). When recurrent nightmaresoccur in childhood, they are "often related to maturational factors and tospecific developmental phases" (Vela-Bueno, Soldatos, & Julius, 1987, p.467). 3 8). Thus, it has been noted that "the generaltherapeutic attitude of respect, interest, support and exploration . Erman, M. Evans, C. The most common "villain" in these nightmares was theperson responsible for the molestation (Garfield, 1987, p. E. These aresleepwalking, sleep terror, and dream anxiety disorder (recurringnightmares). In this regard, overhalf of the reported cases of the disorder are found in children under theage of ten and about two-thirds of the cases are to be found in personsunder the age of twenty (APA, 1987, p. Furthermore, in contrast to dream anxiety disorder, sleepterror disorder is generally more common among men than it is among women(APA, 1987, p. American Journal of Psychotherapy, XLII(4), 61 -618. (1987). Nightmares in the sexually abused femaleteenager. In adulthood,it is normal for nightmares to occur from time to time. In this regard,Hartmann (1984) has indicated that nightmares tend to become more frequentand severe during periods in which a person is experiencing stress ortrauma, or "psychotic or close-to-psychotic episodes" (pp. However, if suchnightmares become frequent and severe in the life of the individual, mostpsychiatrists would agree that psychopathology is indicated (Evans, 1983,p. A. Psychotherapy, 24(3), 363-367. Landscapes of the night: How and why wedream. ThePsychiatric Clinics of North America, 1 (4), 667674. These nightmares usually occur toward the endof the sleep cycle, when the patient is engaged in rapid-eye-movement (REM)sleep (APA, 1987, p. Garfield, P. In one such intervention, a combination of psychodynamicpsychotherapy, paradoxical re-experiencing of the nightmares, andposthypnotic suggestion helped a middle-aged woman in the "amelioration ofthe nightmares and opening of the field for a self-psychological approachto deeper issues" (Gorton, 1988, p. The DSM-III-R notes that nightmare disorder ismore common among women than men.

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