Read on to learn how to stop nightmares in adults. In this post, Emma and Dr. Joanne Davis, a clinical psychologist, discuss how to stop nightmares in adults with or without PTSD.
How to Stop Nightmares in Adults
Dr. Joanne Davis: One of the things that we found in our research is that by treating the nightmares, not only do the nightmares and frequency and severity decline, sleep improves but we also see a pretty significant impact on PTSD symptoms like without even doing the trauma work.
Emma: Okay. Everyone, today we have a great guest! We’re going to be talking about treatment for nightmares especially when those nightmares occur in the context of PTSD and I’ve got a great guest her name is Joanne Davis. She’s a professor at the University of Tulsa and she’s a clinical psychologist who specializes in nightmare treatment and she’s developed a very brief protocol with like five or six therapy sessions that helps people stop having nightmares, decrease the frequency of nightmares, and improve their sleep which is shown to have a really massive impact on PTSD. Really excited to have her on, so let’s jump in. Thank you so much for being here. Really appreciate it.
Dr. Joanne Davis: Thanks for having me.
Emma: Yeah can you tell us a little bit about what you do. Where you work and everything?
Dr. Joanne Davis: Sure. So, I’m a professor at the University of Tulsa in Tulsa, Oklahoma and I’m a clinical psychologist. I do research on nightmares and sleep problems in people who have been exposed to some sort of a trauma traumatic event and I have a private practice as well.
What's Our Brain Doing When It's Dreaming?
Emma: Awesome! That’s great! Okay, well I’m so excited to dive into the topic of nightmares. This is going to be great to talk about. I think so many people struggle with this and a lot of my audience has PTSD or at least have you know past history of trauma. So could you give us like nightmares 101. First off, what’s our brain doing when it’s dreaming and then what happens when we get nightmares and then get stuck in nightmare disorder? Can you just like give us an intro to that?
Dr. Joanne Davis: Sure. Sure. So, there’s a a number of different theories about what is happening when we’re dreaming but I think most people agree that we are processing information about what we’ve gone through during the day. So, during most of the nightmares and dreaming happens during rapid eye movement sleep and so it’s thought that the process of dreaming helps to consolidate memories. So, information during the day is hooked up with longer term memories and it’s usually done on an emotional level. So if you’re feeling stressed out during your day, you may dream about things that have stressed you out in the past or they may be incorporated in your dreams in some way and it’s a way of your brain trying to make sense of things that you’ve gone through during the day. So when it comes to nightmares, there’s a couple of different things that we think about. One is that just as during the day your mind is trying to help you process traumatic events through introducing information to you so through thinking about the trauma when you don’t want to, having images of the trauma when you’re not meaning to think about it. Those types of things that can be very disturbing when you’re experiencing it is actually your mind’s way of helping you to process what happen, to help you figure out why you’re still distressed about what happened. So what happens though is that when these memories or these images are introduced to you, we tend to avoid. So we try to shut it down. Shut it out. Not think about those things and so we end up going through kind of this dance of approach and avoidance where information is presented, it’s distressing. So we try to avoid it and that’s what actually keeps post-traumatic stress symptoms going for a long time cuz we’re just kind of stuck in the stance. Thought about the nightmares is that it is this same process that’s just continuing on while we’re asleep, that the mind is introducing these images and these thoughts and these emotions related to the traumatic event because oftentimes people who have experienced a trauma, their the nightmares tend to be somewhat about the trauma. So it’s never an exact replay of it but it may be similar situations, circumstances. Some of the same people maybe who are around during the a traumatic event and so one of the theories is that this is a means of helping you to try to make meaning of what happened to try to understand at a different level the traumatic event that happened.
Emma: So nightmares or your brain trying to dream or bringing up nightmares is actually potentially your brain’s attempt to process through and work through the emotions and memories of that trauma but something gets stuck. Right? Something happens where it’s not actually processing to the end where it feels better. It just keeps getting stuck and feels worse and worse.
Dr. Joanne Davis: Right. So what happens is that when we’re having the nightmare it gets to the most dysphoric point, which can be scary but people, you know, also may feel shame or guilt instead of fear in their nightmares and then we wake up and so it doesn’t conclude. There’s no closure.
Emma: Right
What Happens When We Wake Up?
Dr. Joanne Davis: And then what happens when we wake up, people have a very hard time often times falling back to sleep. They’re losing a lot of sleep in this process by being woken up throughout the night and then not wanting to go back to sleep or not being able to because it’s so physiologically arousing and then the next day we don’t want to think about the nightmare and so again we we kind of go into that avoidance and so we don’t get to the point where we can process it and that’s how we tend to get stuck.
Emma: Interesting. Yeah. So avoidance is a key feature of PTSD. It’s also a key feature of anxiety and I think my audience is very familiar with how much I talk about avoidance as being the thing that keeps anxiety going.
Dr. Joanne Davis: Yes.
Emma: Would you say that’s accurate for PTSD and nightmares as well like avoidance is the thing that generally keeps them going fuels them.
Dr. Joanne Davis: Absolutely. Yeah. A lot of people that I have seen over the past 25 years that I’ve been doing this, I may be the first person that they talk to about their nightmares. So other people may know that they have them especially bed partners but people don’t tend to talk about the details or what actually is occurring.
Emma: So what does avoidance look like? Okay. They don’t don’t talk about it. What else? Like how do people avoid with PTSD or with nightmares?
Dr. Joanne Davis: So it is a process of suppression. You know, just trying to push away in some manner, thinking about it, not talking about it. You know, with PTSD people tend to avoid people, places, and things. So not only those internal reminders, the memories, the images that are coming up but also those external reminders of the traumatic event as well.
Emma: Yeah, like for example, I had a client who had a traumatic experience in a room with a radiator and then ever after that, she never wanted to be in a room with a radiator. She’s trying to constantly avoid like radiators for example. So okay. So that seems kind of paradoxical because it seems clear like, okay if I have a phobia of let’s say heights, then approaching that would be like, oh I’m going to go up staircases. I’m going to stand near balconies. I’m going to approach that or I’m going to face my fears. How does one face their fears with nightmares or I guess we can move into the treatment aspect here. Okay so when we look at avoidance the antidote to avoidance is approaching but how can you approach or face your fears with nightmares like that seems really hard when it seems like they’re out of your control. They happen at night or whatever.
Dr. Joanne Davis: Absolutely and that’s I think one of the reasons that keeps people from seeking treatment or talking about it with somebody who may be able to be helpful or provide a referral to somebody who can be helpful because they don’t think that there’s anything that they can do about it. So it happens at night. It happens while we’re asleep. So, you know, what are you going to do and people end up, often times, like self-medicating to try to either fall asleep or really quickly so they don’t have to worry about having the nightmare and there’s a lot of fear of sleep that gets involved with people who have frequent recurring nightmares. So they try to use substances that’ll help them fall asleep really quickly or put them into deep sleep hoping not to have any dream experiences.
Emma: So, like drinking alcohol, using cannabis, like sleeping medications, all that. Right?
Different Techniques For Treatment
Dr. Joanne Davis: Yep, all of that absolutely and so the treatment involves, there’s a number of different techniques but there is a piece in which we expose, have people do an exposure to the nightmare itself. So we have them write it out, start to finish in first person, present tense, lots of details. Really trying to engage that the emotions that go along with the nightmares and so that’s one piece of the process in terms of you know, how do you approach it if it’s something that’s happening when you’re dreaming. We do it right in the therapy session.
Emma: You do it while you’re awake in therapy with some support. When you do that, I mean that sounds really scary. I think a lot of people with good reason want to avoid these things that are frightening and avoid the physical sensations that come up, the anxiety, the crying, the shaking; all these things. In that session, are you doing like basically pure exposure where we’re just going to face this or do you also provide resources or encourage them to soothe while they’re doing it?
Dr. Joanne Davis: So usually the exposure comes up in the third session. So this is typically our five or six session protocol. So the first couple of sessions prior to that we’re working on a lot of psycho education. So really helping people to understand why they’re having the nightmares, how it’s related to the traumatic event, how the experience of nightmares has been shaped the way that they think, the way that they behave related to sleep and we start making modifications to people’s sleep habits prior to that session where we’re doing the exposure to the nightmares.
Emma: By that do you mean like sleep hygiene like, oh, let’s improve your environment. Let’s make your sleep high quality or you’re adding in like some kind of like self soothing next to their bed or what do you mean by that?
Dr. Joanne Davis: So, all of that, yes!
Emma: Okay
Relaxation Strategies
Dr. Joanne Davis: So we do a lot of psycho education about sleep habits and then have people to identify what are some of the sleep habits that they may need to think about changing while they’re in treatment. We also teach them a number of different relaxation strategies, so progressive muscle relaxation, diaphragmatic breathing, or belly breathing to help them reduce that cognitive and physiological arousal that people have prior to going to sleep because that’s another thing that we think might be going on is if you’re worried about having another nightmare, afraid of going to sleep, you’re going into that experience with a lot of stress and a lot of arousal.
Emma: Like, you’re priming your body to be anxious in bed and that’s going to make you more likely to like accelerate that cycle.
Dr. Joanne Davis: More likely to have a nightmare. Absolutely and that’s like the mood matching theory of nightmares, is that if you’re going to sleep with all of this arousal and anxiety and stress and fear, then that might, you know, when you’re dreaming, your brain might be choosing things to match that emotion and so it’s going to reach for those very scary images, those very dysphoric images to kind of match how you’re feeling in that moment.
Emma: Yeah, interesting. Okay, so you teach people how to have a little bit better sleep habits, how to relax a little bit before bed, how to make their bedtime a calming experience, and then by session three, you’re doing some exposure therapy. You’re having them write out their nightmare in detail, in first person.
Dr. Joanne Davis: Yes, yes.
Emma: Okay and just straight exposure just like let’s write this down or is it paired with anything else?
Dr. Joanne Davis: So we do the exposure and we don’t do any relaxation while they’re experiencing it, while they’re writing it out because we want to engage that emotion and then we have a conversation after it. So they write it out and then they read it out loud and then we talk about what are the themes that they might be seeing within their night nightmares cuz sometimes people will have like the same one or two nightmares over and over and over again. Other people will have a lot of different nightmares but they may have the same theme. So the themes that we talk about are the same ones that you would discuss in cognitive processing therapy. So power and control, trust, intimacy, esteem, and safety.
Emma: Okay.
Dr. Joanne Davis: So we have them think about which of those themes are coming up in their nightmares and for most people it’s more than one theme. So they may feel like they don’t have any power control in what’s happening in the nightmare and they may feel really unsafe, so it it’s not just one theme it tends to be usually a number of themes. So we have them figure out what themes are being represented and then we shift into rewriting the narrative based on those themes. So we’re going to brainstorm with people how can you change what is happening in the nightmare to handle that theme. So if they’re feeling powerless and out of control in the nightmare, then we’re going to brainstorm ways that they can take agency that they can have some power in what’s happening and then we brainstorm and we talk about, you know, what are some possibilities and then we have them choose a new narrative that they’re going to write out and then they do the same thing. So they write it out first person, present tense, lots of details but it’s going to be a different story than the nightmare. What we’ve discovered along the way is that it can’t be a completely new narrative. So it has to be somehow connected to the nightmare. So it’s not just writing a pleasant story.
Examples Of How Clients Rewrote Their Story
Emma: Okay. Could you give me some examples like some anonymous client examples like what was like the theme of someone’s nightmare and then how did they rewrite it.
Dr. Joanne Davis: A lot of people have nightmares that involve being chased. So I remember there was one individual who was being chased and it was a wooded environment and this is somebody who had the trauma had been interpersonal violence. So that wasn’t directly represented in the nightmare but it was her being chased through the woods and the nightmare was about, you know, like falling over twigs in the forest and feeling like the person or the thing that was chasing them was just about to get them and then at some point, they wake up from the nightmare.
Emma: Isn’t that the case where it seems like you always wake up right before the bad thing happens?
Dr. Joanne Davis: Yep. Yeah, right at right at the most intense part. Yeah.
Emma: That’s what keeps nightmares going too, anyway. Okay, keep going. Okay so she’s being chased all right.
Dr. Joanne Davis: So being chased through yeah and so this person initially chose to hide behind a tree and have the thing, the perpetrator or the thing that was chasing her, just run right by and not notice and so she watches the person keep running off through the woods and she’s behind a tree and one of the things that we talked about in the session was that by hiding behind the tree, she was able to enhance her sense of safety. However, it was a very temporary sense of safety because, at any point, the person or the thing could have turned around and come right back and so we talked about what are some ways that you can, one, take some more agency because power and control was also a piece of this but also have a more permanent sense of of safety and so she ended up writing a narrative in which it started out the same, she was running through the woods, somebody was running behind her, she ducked behind a tree, was able to pull out her cell phone, call the police, and watched as the thing that was chasing her ran past and she saw that there were police officers waiting at the end of the woodline and she saw this person getting arrested, said to her we’ve got him now. There was there was agency in that. She was the one who like whipped out the phone and made the phone call and there was a more sense of permanence of the safety because she saw that this person was being taken away.
Emma: When people rewrite their narrative, is it okay for them to use fantasy and then I stood up and I pulled out my katana and I like became a four and you know, like they like create this fantasy where they’re suddenly like a powerful being and like kicking this thing in the teeth or something like that. Is that all like acceptable? Can they go anywhere with this or does it have to be …
Dr. Joanne Davis: They can go anywhere with it. Yeah and we’ve had people who’ve done just really fantastical kinds of and it can be like superhero powers, you know, or shining the bat signal into the sky and Batman, you know, comes. There are people who choose to make it very concrete like don’t want to have that fantastical component and then a lot of people also choose humor, which is really interesting. So they choose to create something that’s amusing or funny in some way and it’s really hard to hold amusement and humor and fear and anxiety at the same time. So that can be a very powerful way of approaching it. Doesn’t work for everybody.
Emma: It’s like [inaudible] from Harry Potter.
Dr. Joanne Davis: It is exactly that. Yes, when I do trainings I tell this story that I had given a talk in South Dakota many years ago and it was all about the use of humor in doing this kind of therapeutic approach and I had somebody come up to me afterwards and he said, “You know, Dr. Davis, what you have here is the ridiculous treatment.” And I was mortified. At first, I was like he’s calling my treatment ridiculous and he just like no, no, no Harry Potter. That’s the charm that they use with the Boggart.
Emma: That’s right! Ridiculous or something like that. That’s awesome. Yeah. Okay. So would this be all in session three like in the same session? They write the whole narrative normal and then they rewrite it, rescript it with a different ending?
Dr. Joanne Davis: So there are different ways of doing it. Traditionally, that’s how I’ve done it in the past but that takes a longer session. Usually that’s about a 90-minute session and not all clinicians and [inaudible] have that flexibility to do that. So the other way to do it would be to do the exposure and then to have the conversation about the rescription and then have one of the assignments be that the person, you know, takes the week in between sessions to think about how they want to rescript and then you do the actual rescription in the fourth session.
Emma: Yeah. Yeah, I can see benefits to both cuz I can imagine like writing out that trauma story or the nightmare story could take someone to a place where they need a lot of time to re-regulate and that would take up the rest of the session and like just like talking and calming and like restoring their sense of safety but leaving them without doing the next step could mean, like, oh, they have this whole week where they’re like kind of have that hanging over them.
Dr. Joanne Davis: Yeah we definitely end the sessions doing some sort of a relaxation technique. So, we do not want people to leave the session feeling really distressed, of course. So, we want them be able to sit with the distress while they’re writing out the nightmare but want to try to help them to re-regulate before they leave. One of the things that we have also noticed over the years that we’ve been doing this is that the act of writing it out is really powerful and in and of itself can be very healing because, again, this is something that people have avoided oftentimes for years and years and so that experience of being able to face it is can be incredibly, give you a sense of mastery almost.
Emma: I love it that’s awesome.
Dr. Joanne Davis: Yeah
Emma: So, I made a video on exposure therapy last year and so I’m a climber but I’ve had four kids in between like climbing a lot and I got really scared of lead climbing which involves falling and so I went to the gym and I’d go to the gym every single week and I’d practice falling 10 times in a row. The first two or three falls I’d take, I was just gripped. By like 3 or 4, I was like okay, okay, and by like 5 or 6, I’m like I’m getting a little bored of this, like, can I do something else now? But then after I those sessions, even though fallen, gotten scared, I felt like, really proud of myself. All right, Emma! Like, you did something scary today. Like, good job! Way to go! I would imagine people when they do that they’re, like, I face my fear! I wrote it down. I shared it with someone. I said it out loud. Like all of that’s like empowering. That’s cool! That’s really cool!
Dr. Joanne Davis: Absolutely and I remember very clearly, one of the first clients that I had, she had an experience of interpersonal violence when she was a young teenager and by the time I saw her, she was in her mid-40s and she had been having weekly recurring nightmares since that time so many many many years and when we, you know, I gave the instructions for what I wanted her to do, writing out the nightmare and she was really nervous and anxious about doing it but she was like, okay, here we go and wrote it out. She wrote it out and she was crying a little bit while she was doing that but then she sat back in her chair and she just looked at the piece of paper and she had this quizzical look on her face and I said, “Hey you know let me in what’s what’s going on here.” And she said, “This is what I’ve been afraid about this whole time? Like, this is the thing that has been haunting my …. I can handle this!”
Emma: That’s cool, right?
Dr. Joanne Davis: Yeah, so powerful!
Emma: It’s so easy to run from the things that scare us whether that’s worries or the fear of abandonment or nightmares or like sensations in our body when we sit down with it just long enough to like hold still, face it and get really make it external it’s like actually I am capable I am capable of this. It’s really cool.
Dr. Joanne Davis: Absolutely.
What Else Is Involved With The Treatment?
Emma: Okay, so what else is involved with the treatment like what else how else do people or are there other steps?
Dr. Joanne Davis: So that was session three and four. So when people, after they do the rescription, we assign them to do imagery rehearsal. So part of this treatment approach is derived from imagery rehearsal therapy that you mentioned earlier and so they will do their bedtime routine and get into bed and then they will think through and vividly imagine their new version, their rescripted dream. So they’ll do that for about 5 to 10 minutes, trying to imagine it in as much detail as possible. Then they’ll do their progressive muscle relaxation and then fall asleep. So that’s the next component and then after that, when they come back in, usually by this time you’re seeing lots of change, you’re seeing lots of of differences, what we tend to see is that people may still be having the nightmare, so the frequency might not be going down but it’s just not the same. So it just doesn’t bother them as much or they’re seeing it more from a distance. So it’s almost like, watching it from afar instead of being a part of it or some people will talk about that the imagery is not as intense as it as it was before. It’s more fuzzy now. So it’s almost like we reduce the power of the nightmare and then over time they just stop. They go away and typically people don’t actually, it’s kind of unusual for people to actually dream the rescripted version. It’s just that the original nightmare starts to go away until they’re not having it anymore. Yeah.
Emma: That’s really cool.
Dr. Joanne Davis: If they come back and that hasn’t happened, then I would go back and say, okay, maybe we didn’t get the theme right. Maybe there’s something else going on that needs to be addressed or maybe the rescription wasn’t powerful enough in some way and so we’ll brainstorm ways to kind of work with that rescription to come up with something different. Other people have different kinds of nightmares and so may choose to do an exposure to a different nightmare in the fourth or fifth session.
Emma: Oh, so like if they’re having a nightmare about being chased and then another time they have a nightmare about being like I don’t know some other, like being in a war situation, then you’d work through the other type of nightmare using the same process.
Dr. Joanne Davis: Yeah, typically what we find is that if you focus on the worst nightmare and this is one of the ways in which our approach is different from what other people do, we focus on the most disturbing nightmare first and what we have found is that if you do that, then you don’t have to then address every other nightmare that they may be having. It’s just they start to go away as well. So by just working on the most significant one.
Emma: Why do you think that is? Do you think the brain learns like, oh, I can process nightmares now? Like this new like sense of self-efficacy or belief in your ability to like, oh, I can handle this. Why is that?
Dr. Joanne Davis: Yeah, absolutely. Well, I think there’s a lot of things going on that may be contributing but part of it is that sense of mastery cuz when you’re having nightmares that are similar themes, like if you’re having nightmares of powerlessness and being out of control and that can play out a lot of different ways, a lot of different storylines but if you’re addressing that sense of powerlessness and being out of control, then that will may generalize to other nightmare experiences within that same kind of theme. The times that we may need to go and work on a different nightmare is if they’re also having nightmares that include different kinds of themes. So if they are having power and control nightmares but they’re also having like trust and intimacy nightmares, then we might need to do work on both.
Emma: Interesting! Do these five themes show generally just in nightmares or is this like a theme related to fear that’s universal, these five themes?
Dr. Joanne Davis: Yeah, I’m not sure. So, the themes come from the idea that those are the areas that trauma is going to impact you in and that’s how Patty Resick developed cognitive processing therapy, that those were the ways in which trauma was going to change the way that you thought about things, the way you felt about things and how you behaved because of of those five themes. So it made sense when I was putting this together that that would also be showing up in people’s nightmares.
The Five Themes
Emma: Yeah, could we walk through like examples of the themes? Tell me the five themes again and then give me an example of like the first one and how that might show up in a nightmare and then what someone might rescript.
Dr. Joanne Davis: Sure. Okay, so the first one is power and control and so this is feeling like you don’t have any agency, like things that are going around on around you, you don’t have any say in it basically and during the day, this can come out. This can look like people who either try to control everything so they, you know …
Emma: Like micromanaging …
Dr. Joanne Davis: Work very hard to micromanage, yeah, exactly. Yeah or they do the opposite, where they’re like, I don’t have any control and so they’re very indecisive.
Emma: Why bother?
Dr. Joanne Davis: Exactly and so in nightmares, this can come up in so many different ways, just things happening around you that that you don’t have any control over. It could be somebody who’s in a combat situation and they’ve been trained how to fight. They know how to use a gun but in their nightmare, nothing’s working, like they can’t fire their weapo, like they don’t like all of their actions just aren’t leading to what they know should happen and so they feel like you know, they don’t have any power in that situation and so they can rescript that by being able to talk themselves through, this is what I do next and then this is what I do next and this is what I do next. That they can even like change the kind of weapon that they have or maybe they don’t even have a weapon, it’s actually one of those guns that shoots bubbles instead of bullets you know, so they can change a lot of different aspects of it.
Emma: Okay.
Dr. Joanne Davis: The next one is safety.
Emma: Interesting. Okay.
Dr. Joanne Davis: So people feeling unsafe in a situation and during daytime hours, this can look like hypervigilance, like always looking over your shoulder, feeling like you’re unsafe, feeling like somebody’s always to get you kind of thing and shows up in nightmares and that bad things are happening, that you are about to be injured in some way and so people generally resolve that. Usually that’s tied with power and control. So they usually resolve the safety issue by doing something taking some action or bringing other people into the situation to help them out. I had somebody who was having a nightmare about being brought to this location and there were other people there who intended her harm and started to physically assault her and so she felt very unsafe, very out of control. Nothing that she could do in that situation and then when she rewrote it, she ended up somehow she like yelled out during the assault and her father came through the front door and the two of them together beat up the people who were assaulting her.
Emma: Excellent! Yeah, love it.
Dr. Joanne Davis: The next one would be trust. So this is feeling like you can’t depend on other people and we see this sometimes in in people who have experienced like interpersonal violence or combat and so the nightmare may be that you know, you have a plan for how you were supposed to engage in a certain operation but nobody else is doing their job and so you feel like you’re stuck and now you’re in more danger because nobody else is doing what they’re supposed to do or you in a bad situation and you’re looking around trying to catch people’s eyes or or get other people to pay attention and help you out and nobody does. So when we rewrite it, a nightmare like that, it would be imagining or or rescripting it so that there are people there who you can trust and you can say, hey I need help here and they come and help you out. And then there’s esteem so that usually has to deal with bad feelings about yourself in some way like, I should have done …
Emma: This isn’t like the classic naked dream? This is something else?
Dr. Joanne Davis: Usually something else.
Emma: Yeah. Okay. All right keep going
Dr. Joanne Davis: So, yeah feeling like I should have done something different. Whatever is happening is in some way my fault. So we tend to see this with people who have experienced loss as a part of their trauma and feel like maybe they didn’t do enough. Somebody who lost a buddy and comrade or lost a comrad in combat or you know, somebody who experiences some other kind of of a traumatic loss and typically when it comes to nightmares about loss, it is very unusual for somebody to rewrite it to bring that person back to life like in a in a permanent way. Usually, I’ve seen people rescript those nightmares by having a conversation with the person that they didn’t get to have before they left. And this can be like, I’ve seen people right, like, as a person is dying in combat then being able to say, hey, I got you and I’m going to take care of your family, like, I’m going to leave here, I’m going to go take care of your family. You’re okay. You can go now or parents who have lost kids like opening up a portal and being able to have a conversation with their child. Very intense. Very intense.
Emma: Tender, yeah. Really tender.
Dr. Joanne Davis: And then the last one is about intimacy and these are in some ways related to trust in that there’s not a sense that the people that you expect to be there for you and around you are there. So, it’s I’m trying to think of a good example. Nothing’s coming to me right now.
Emma: That’s okay we can come back to it too. Well, I think with trauma it’s always great to do it in the company of someone else because there’s a lot of shame involved with trauma and like shame dies in the sunlight, right? Like, we have to connect, connecting with a human is part of healing. You can’t just ignore that aspect of it.
Dr. Joanne Davis: Yeah.
Emma: Well that’s good that’s great! Any treatments for night terrors? So I’ve been researching night terrors and they happen usually in a different way of a different stage of sleep. They usually happen in like light sleep moving into deeper sleep, right?
Dr. Joanne Davis: So they happen in stage three sleep. That’s where most of the parasomnia happen.
Emma: And usually they aren’t related to PTSD but I was learning that sometimes they can be. They sometimes can be related to PTSD.
Dr. Joanne Davis: Yeah, I think …. So, the parasomnias tend to go hand in hand and a lot of times, there seems to be some genetic family links to people who experience parasomnias. The best treatment that I’m aware of for sleep terrors is actually scheduled awakening.
Emma: Yeah.
Dr. Joanne Davis: Yeah. So people typically have them around the same time each night. I think it’s usually like the first slow wave sleep episode that they’ll go into and so if you can wake somebody up about 15 to 20 minutes prior to that time, then they tend to then go back to sleep and sleep through and not have them.
Emma: So interesting. Are there any genetic predispositions for nightmares or sleep or like sleep conditions that predispose nightmares like sleep apnea or other like wakening things?
Dr. Joanne Davis: So some of the sleep disorders do seem to have some possible genetic links to it and I know with like with obstructive sleep apnea, it’s comorbid with insomnia. It can be comorbid with nightmares, pretty high frequency of those two things together and part of that may be that sense of of not being able to breathe and choking may actually trigger nightmare experiences. So, I know that when you treat sleep apnea, the nightmare frequency tends to go down like doesn’t usually get rid of them and it’s not like the cure for nightmares but it can be helpful. Yeah.
Emma: Yeah, interesting.
Dr. Joanne Davis: I love doing the the nightmare approach and and the sleep in general like treating sleep issues cuz they tend to be so much briefer and you see success quickly, yeah.
Emma: I love what you’re describing too cuz it’s like oh five or six sessions where it’s like, I think a lot of general therapists, like myself, I’m a licensed marriage family therapist, I’m not a clinical psychologist, I didn’t go through psychology training and a lot of therapists with a master’s degree have never been taught like some of these CBT skills that make treatment very short. So they might do talk therapy for two years about what’s fueling your nightmares and it’s like, come on! Like, you just don’t know, like, the actual treatment that is more effective and more more rapid and that makes therapy more accessible too.
Dr. Joanne Davis: Yeah. one of the things that we found in our research is that by treating the nightmares, not do the nightmares and frequency and severity decline, sleep improves but we also see a pretty significant impact on PTSD symptoms like without even doing the trauma work and so you know, when I do trainings with clinicians, I talk about, you know, if somebody has nightmares as a part of PTSD but it doesn’t seem to be like the main driver of the distress, then probably treating the PTSD first and then seeing what happens but if it’s the nightmares that really seem to be, you know, one of the most significant things and really kind of fueling everything, then start with the nightmares, you know, and then see if, you know, you even need to do the PTSD treatment afterwards. I think most people probably would but, yeah, it’s something to think.
Emma: Still very impactful and you think about why and it’s like well, one, we’re we’re helping the brain process these memories. So if the brain can process these memories at night, it’s going to start filing like chipping away at this old like backlog of memories, right? And you’re going to develop that feeling of confidence like, oh, I can like, I can process these feelings but we’re also improving sleep and sleep is one of the most impactful measures of mental health. Right? Like if you sleep good, you’re much better at managing the triggers that show up during the day or working through your emotions and not overreacting and doing stupid stuff that makes you feel worse later. So that’s cool.
Dr. Joanne Davis: I think it gives you like, you know, you’ve got then the cognitive and emotional resources, you know, when you’re sleeping better to then, you know, yeah deal with the other stuff that’s going on.
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