All in the Mind: Recurring Nightmares and Chronic Trauma

Recently, BBC’s All in the Mind programme hosted a segment where they discussed a new study being conducted by their guest Bryony Sheaves, a research clinical psychologist at Oxford university. The discussion centred around use of Trauma-focused Cognitive Behavioural Therapy techniques to treat the nightmares of patients with psychosis, in the hopes that their waking symptoms would also subside. 

Using a control group of 24, the team used a very brief course of targeted TFCBT, specifically the technique of imagery re-scripting. This involved cognitively reframing the most intensely distressing elements of the nightmares in session, and saw some reduction in the frequency and intensity of the nightmares overall, something that is typically only achieved with anti-psychotic medication.  

The study is still ongoing, but it is likely that this is due to there being two different causes of frequent nightmares that are being treated. Many of the nightmares that remained were those which had no clear theme or reoccurring elements, something that is to be expected of a psychotic episode during sleep.

These can be compared to the phenomenon of ‘repeating nightmares’ which many non-psychotic people find themselves experiencing to a degree that infringes upon their quality of life. As cited on the programme, as many as 10% of people are believed to experience intense nightmares at least once a week.  

It’s an interesting distinction to have identified, and we’re hopeful that the study will yield productive results. One of our reasons for having faith in this study is our own experience of having utilised targeted trauma recovery therapies, such as TFCBT and EMDR in treating issues like recurring nightmares, flashbacks and PTSD. In the case of nightmares specifically, we have found that these modalities are effective even for those who have tried talking therapies for their symptoms in the past, and not found it persistently helpful. 

This is because often, the root cause of the issue is very deep seated. Through a neurological lens, it relates to the formation of fragmented memories within the brain and nervous system which other therapeutic models may not access.  Normally, when a memory is formed about an experience a person has had, the sensory details enter the mind through the lowest, most basic area of the brain, the brain stem, which deals only with the very basest survival needs. Next, it transfers into short term memory, and and gets sorted over time into the long-term memory. 

This sorting process is a natural function that is always progressing, we have very little influence over it. However, the majority of it occurs during the Rapid Eye Movement (REM) stage of sleep, when we dream. Dreams are essentially a visualisation of our brains taking fragmented chunks of information from the ‘to-sort’ pile, creating meaning from them by creating symbolic images for us to experience by association, and filing them away in the appropriate area of long term memory when they’re done.  

However, this process is dependent on the received information flowing upwards through the brain unimpeded. If the brain detects an emergency, it will disengage unnecessary sections of the brain to focus on survival. Unfortunately, this means that the resulting memories of the event become fragmented. The fragments that are retained once the distressing event has ended are infused with all of the most intense, overwhelmingly negative feelings that were being experienced in the moment that they were formed. This is because the memories are formed of both sensory and emotional information. 

However, as mentioned, the brain is always attempting to clean these shards up and sort them away where it finds them. Sometimes this will happen while awake if we are reminded of the event, perhaps smelling or hearing something that triggers the associated memory, and the overwhelming emotions that came with it. Alternatively, the brain may come across the memory on its own during sleep, and construct a nightmare to represent those emotions. E.g. feeling helpless, unprepared, in lethal danger, etc.  

This may present an opportunity for the brain to finally come to terms with those feelings now that the real emergency is over. However, if it is still too much for a person’s mind to cope with on their own, the fragmented memories will be discarded again as a defence mechanism, only to return again during future nightmares and triggering events, beginning a repeating pattern that reoccurs indefinitely.  

The treatment that is recommended for this issue is the very targeted trauma recovery modalities mentioned before. These can be utilised to hone in on the fragmented memories that are still circulating in the mind and body. The therapist can then draw them forward and guide the client through the otherwise impossible prospect of overcoming their trauma, supporting them in their vulnerability to come out the other side of the process. After this, the brain is able to fully resolve the memories, sorting them into long term memory and ending the cycle of nightmares.  

If you are interested in learning more about out trauma-recovery therapy services, or would like to discuss sourcing treatment for yourself or somebody you know who may benefit from it, please contact us on 1282 685345 or send us an email at office@jsapsychotherapy.com

You can listen to the broadcast of All in the Mind online at: https://www.bbc.co.uk/sounds/play/m000wrlz