Monday, June 11, 2007

Lucid Dreaming in the Treatment of Veterans and Others with Post Traumatic Stress Disorder

Lucid Dreaming in the Treatment of Veterans and Others with
Post-Traumatic Stress Disorder

Regardless of what one feels about the war in Iraq and Afganistan, the men and women who are fighting it are true heroes and they deserve our support both while at war and when they return home. And yet, the U. S. Department of Veterans Affairs is woefully unprepared to help both the physically and psychologically disabled veterans who are coming home. A recent article in the Los Angeles Times reported that there is now a law suit that has been filed in federal court on behalf of thousands of veterans. The article stated in part that there is a "backlog of 600,000 claims, the adequacy of its services and the long waits to receive mental health care, particularly for post-traumatic stress disorder (PTSD), which is described as the 'signature problem' of vets returning from the current fighting." (1)
Despite the fact that PTSD is the most often reported mental health issue reported among veterans, according to the article only 27 of the VA's 1400 hospitals have in-patient treatment programs for PTSD.
Nor is PTSD confined to war. It can result following being confronted with any event or series of events that involve actual or threatened death or serious injury, or a threat to the physical integrity of the person. These events include such things as violent traffic accidents, rape, being physically attacked, or being threatened. The symptoms are most often an increased response of intense fear, recurrent nightmares, helplessness and horror. In children, PTSD is often characterized by disorganized or agitated behavior. The traumatic event is replayed mentally in a manner that is intrusive. This causes PTSD patients to often avoid stimuli associated with the traumatic event and they sometimes experience a numbing of general responsiveness that was not present prior to the trauma. Finally, there are symptoms of increased arousal, an exaggerated startle response and difficulty falling asleep.
Probably the most debilitating of all these symptoms for many victims is the often intense and recurrent nightmares that occur for months, years, even decades following the traumatic event. Many veterans and others with PTSD have such difficulty dealing with their nightmares they resort to the abuse of alcohol and other substances in an attempt to simply get through the night without waking up from often terrifying dreams related to the traumatic event or events they experienced. This often compounds the clinical picture as the individual develops a secondary psychological problem involving substance abuse. Others become sleep deprived because they either can’t or don’t want to go to sleep for fear of experiencing yet another terrible nightmare. Sleep deprivation over time is extremely stressful and leads to irritablity, depression and even suicide.
Given all this, one would think that those mental health professionals who treat veterans would be extremely interested in any therapeutic modality that would be helpful in the treatment of individuals with PTSD. Yet, there is a modality that to my knowledge is not being used that can fairly easily learned, is cost effective, has no negative side effects and has the potential to help literally millions of PTSD sufferers completely eliminate nightmares. That therapeutic modality is lucid dreaming and the purpose of this article is to describe lucid dreams and how they help in the treatment of PTSD in the hope that (a) victims of PTSD will seek out this modality for themselves and, (b) the military and others who work with victims of PTSD will begin to use what can only be described as an invaluable tool.

__________

A lucid dream is one during which the dreamer becomes conscious during the dream that he or she is, in fact, dreaming. The person continues to sleep and dream, but once lucid, they become as conscious as they are during their everyday waking life. And if while conscious within the dream state, the person is able to face the dream image that has been causing their nightmare, that particular dream will never reoccur.
Exactly why this is so is open to debate, but from clinical experience this has been long known to be the case. My own conclusion is that the nightmare is the subconscious attempting to make the individual conscious or aware of something. Once the person has literally become conscious within the dream state, the dream has served its purpose and there is no psychological reason for it to reoccur.
When many people first hear about lucid dreaming, they are skeptical. How can a person be unconscious, yet conscious, asleep, yet awake?
Lucid dreaming actually has a long history. In the 17th century the Marquis de Denys wrote a book about his own lucid dreams that was apparently fairly widely circulated. (Freud mentioned in his landmark study The Interpretation of Dreams attempting and being unsuccessful at getting a copy of de Denys book).
In 1913, a psychiatrist by the name of Frederik van Eeden published an article entitled A Study in Dreams. It was in that article that he first used the term lucid to describe these conscious dreams and the moniker stuck.
In the late 1970’s Keith Hearst in England, and Stephen LaBerge in California both devised experiments that proved that it was indeed possible to be both asleep and fully awake. LaBerge and Hearst, both accomplished lucid dreamers themselves, realized that to convince skeptical colleagues they would need to demonstrate that they were both dreaming and fully conscious at the same time. To do this, they would need to become lucid and somehow signal from within the dream state, thereby proving that they were conscious, in a manner that could be detected using physiological measurements.
The problem they faced was that most of the body’s muscles are paralyzed during the period of sleep in which dreaming occurs. The eye muscles are one of the few exceptions to this. In fact, it is the rapid back and forth movement of the eyes, called rapid eye movement (or REM), which signals that people are dreaming. Because of this, both LaBerge and Hearst reasoned that it would be possible to become lucid within the dream state and perform a series of predetermined eye movements that could be detected by monitoring devices, which they both were able to do.
In LaBerge’s case, he spent a night in a sleep laboratory during which he was monitored by a number of different instruments. He became conscious within a dream, remembered that the task he had set for himself was to spell out his first name, Stephen, in Morse code by using left and right eye movements. He was able to do this and those eye movements were recorded on a devise that monitored eye movements. For the first time, a dreamer had successfully sent a conscious message from the dream state into physical reality. Other researchers have since replicated these experiments with other lucid dreamers. Faced with this evidence, even the most skeptical scientists were forced to accept that lucid dreams are, in fact, conscious dreams, as well as a very interesting altered state of consciousness.
Moreover, LaBerge and others have shown that lucid dreaming is a teachable skill and anyone who has enough motivation can be taught to have lucid dreams. And because lucid dreams can be taught, we can use it as a direct modality in helping PTSD patients learn to overcome their nightmares.
By confronting one’s fears in nightmares while lucid, they loss their frightening quality and any fear is quickly dissipated. The following dream is one in which the dreamer was able to do this:

I began to try to recognize my dreams as products of my mind, even as I dreamed them. The breakthrough came one night soon after a nightmare. I decided I could not live fully while I let my fears roam about on their own power, so to speak. I entered the dream state determined not to yield. I had read somewhere that a fear could only be dissipated by friendliness and trust. Anger, threats, aggressiveness were out. These reactions were actually fearful reactions. So I made up my mind to be friendly.
The dream evolved, and I barely had time to remind myself to smile before the nightmare began. This time it was an almost childish nightmare, in which my collective fears took the shape of a large, nebulous but very scary monster. I quailed and almost turned tail, but by sheer will (I was really scared) I stayed and let it approach. I said to myself “it’s my dream, and if I forget this, I’ll have to go through it again,” and I smiled as sincerely as I could. What’s more, I spoke as calmly as I could, a big step since waking or sleeping terror leaves me speechless. I said
something like “I’m not afraid. I want to be friends. You’re welcome to my dream!” and almost as soon as I said it, the monster became friendly, delightedly so. I was ecstatic. Needless to say, I awoke quickly, still saying “I did it!”


A few years ago a 12-year-old girl was referred to me following being mauled by two dogs. Her younger brother was being bitten by the dogs and she ran to help him. In doing so, she was also seriously bitten. Following this, she had a recurrent nightmare in which she was being chased by two dogs and ran and hid behind a tree. I explained to her that dreams were like cartoons in which the dreamer's mind was making up the story. Because her mind was making up the story, I told her she could become aware that she was dreaming while the dream was ongoing and change it in any way she wanted. I suggested that every night as she fell asleep she put herself back into the dream at the point where she was hiding behind the tree and say to herself that she was dreaming. Then she could change the dream in any way she wanted.

Two weeks later she walked in for her appointment and told me that she had done what I had suggested. She had found herself back in the dream and remembered that it was a dream and she could do anything she wanted to. She stepped out from behind the tree, looked at the two dogs and told them she wanted them to turn into hot dogs. The dogs almost immediately obeyed the command, turned into hot dogs and she ate them. Since that time, she has not had the nightmare.

I recently worked with a man who had been in Viet Nam and who reported having had the same recurrent nightmare for decades. In the dream he is in a firefight with the Viet Cong and bullets are flying all around him. At one point in the dream he saw one of his friends fall seriously wounded a few feet away from him. He kept firing as he tried to get to where his friend was. When he reached him, he found that he was dead. He then woke up, his heart pounding. He'd had this dream for three decades.
I described the value and the methods involved in lucid dreaming. Because his dream was always the same, I suggested he pick one particular moment in the dream and each night as he fell asleep to mentally and emotionally visualize himself back in that particular moment and say, “This is my dream.”

A few weeks later he came in for his session and reported he had used the moment when he found that his buddy had died as the signal that he was dreaming. One night he had again had the nightmare, but this time as he reached his friend he was able to realize that this was a dream and he could choose to direct it in any manner he wished. He decided to tell his friend to get up, that the war was over and they were all going home. In the dream, his friend sat up, smiled and they got up and walked off the battlefield. It has now been over two years and he has not had this nightmare since.
In his book, Dreaming in the World's Religions: A Comparative History, Kelly Bulkeley wrote: "Particularly at a time when mental health professionals are seeking improved methods of treating people suffering from post-traumatic stress disorder (PTSD), the value of recognizing and actively working with the dimensions of existential fear and religious transformation in dreaming can be tremendous if the therapeutic goal is to heal the whole person (as opposed to simply eliminating his or her behavioral problems)." (Bulkeley, 2008, p. 271).
I couldn't agree more.
Lucid dreaming is one method that has the potential to be helpful for many veterans and others with PTSD. To not use it, to not make people at least aware of its potential value and provide them with some one who can teach them to learn this skill is just one more indication that we have failed to help those men and women who fought to maintain our freedom and way of life.


J. Timothy Green, Ph.D. is a clinical psychologist and freelance writer in private practice in Mission Viejo, California. He can be reached by email at: jospeverde@aol.com

14 comments:

dungan said...

Thanks so much for sharing this story about lucid dreams and PTSD. There are not too many people blogging about lucid dreams - especially with a perspective of healing.

With all the money going into psychiatry in order to stop nightmares with pills, it is refreshing to see the older ways making a come-back in therapy.

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