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Nightmares and PTSD: Characterization, Theories, and Treatment Approaches

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Comprehensive Guide to Post-Traumatic Stress Disorders

Abstract

Twenty-five years ago, the nightmares typically experienced in the course of PTSD were first referred to as a hallmark of the disorder. PTSD-related nightmares share some characteristics with idiopathic nightmares, but the often trauma-replicating nature of disturbing dreams experienced by individuals with PTSD continues to be a key clinical manifestation of PTSD. A number of validated measures have been developed to measure the frequency, intensity, content, and clinical significance of nightmares. The neurobiologic mechanisms underlying the development and persistence of replicative nightmares in PTSD are still being investigated. Two sets of psychological theories of dreaming, threat simulation theory and theories related to emotional adaptation, provide some context for understanding nightmares. Clinically, nightmares in PTSD are associated with significant distress and morbidity. In addition to psychological interventions that may reduce the frequency and intensity of nightmares, numerous medications have been evaluated for the treatment of nightmares with prazosin standing out as the most promising of these pharmacotherapies.

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Abbreviations

CAPS:

Clinician-administered PTSD scale

CBT:

Cognitive-behavioral therapy

CBT-I:

Cognitive-behavioral therapy for insomnia

DSM 5:

Diagnostic and statistical manual of mental disorders 5th edition

IRT:

Imagery rehearsal therapy

NM:

Nightmare

PTSD:

Post-traumatic stress disorder

RCT:

Randomized controlled trial

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Authors and Affiliations

  1. Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY, USA

    Wilfred R. Pigeon

  2. Sleep and Neurophysiology Research Lab, University of Rochester Medical Center, 300 Crittenden Blvd. – Box PSYCH, Rochester, NY, 14642, USA

    Wilfred R. Pigeon

  3. Dream and Nightmare Laboratory Center for Advanced Research in Sleep Medicine, Hopital du Sacre-Coeur de Montreal, 5400 boul. Gouin Ouest, H4J 1C5, Montreal, QC, Canada

    Michelle Carr

Authors
  1. Wilfred R. Pigeon
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  2. Michelle Carr
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Correspondence to Wilfred R. Pigeon .

Editor information

Editors and Affiliations

  1. Faculty of Society and Health, Buckinghamshire New University, Uxbridge, Middlesex, United Kingdom

    Colin R. Martin

  2. FactyofLifeSci&Med,Diabts&NutrnSciRshDiv, King’s College London, London, United Kingdom

    Victor R. Preedy

  3. DepartofBiomedicalSci,SchoolofLifeScienc, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Pigeon, W.R., Carr, M. (2016). Nightmares and PTSD: Characterization, Theories, and Treatment Approaches. In: Martin, C., Preedy, V., Patel, V. (eds) Comprehensive Guide to Post-Traumatic Stress Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-08359-9_71

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