Nightmares and PTSD

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Nightmares refer to complex dreams that cause high levels of anxiety or terror. In general, the content of nightmares revolves around imminent harm being caused to the individual (e.g., being chased, threatened, injured, etc.). When nightmares occur as a part of PTSD, they tend to involve the original threatening or horrifying set of circumstances that was involved during the traumatic event. For example, a rape survivor might experience disturbing dreams about the rape itself or some aspect of the experience that was particularly frightening.

Nightmares can occur multiple times in a given night, or one might experience them very rarely. Individuals may experience the same dream repeatedly, or they may experience different dreams with a similar theme. When individuals awaken from nightmares, they can typically remember them in detail. Upon awakening from a nightmare, individuals typically report feelings of alertness, fear, and anxiety. Nightmares occur almost exclusively during rapid eye movement (REM) sleep. Although REM sleep occurs on and off throughout the night, REM sleep periods become longer and dreaming tends to become more intense in the second half of the night. As a result, nightmares are more likely to occur during this time.

How common are nightmares?

The prevalence of nightmares varies by age group and by gender. Nightmares are reportedly first experienced between the ages of 3 and 6 years. From 10% to 50% of children between the ages of 3 and 5 have nightmares that are severe enough to cause their parents concern. This does not mean that children with nightmares necessarily have a psychological disorder. In fact, children who develop nightmares in the absence of traumatic events typically grow out of them as they get older. Approximately 50% of adults report having at least an occasional nightmare. Estimates suggest that between 6.9% and 8.1% of the adult population suffer from chronic nightmares.

Women report having nightmares more often than men do. Women report two to four nightmares for every one nightmare reported by men. It is unclear at this point whether men and women actually experience different rates of nightmares, or whether women are simply more likely to report them.

How are nightmares related to PTSD?

A person does not have to experience nightmares in order to have PTSD. However, nightmares are one of the most common of the ‘re-experiencing’ symptoms of PTSD, seen in approximately 60% of individuals with PTSD. A recent study of nightmares in female sexual assault survivors found that a higher frequency of nightmares was related to increased severity of PTSD symptoms. Little is known about the typical frequency or duration of nightmares in individuals with PTSD.

Are there any effective treatments for nightmares?

Yes. There are both psychological treatments (involving changing thoughts and behaviors) and psychopharmacological treatments (involving medicine) that have been found to be effective in reducing nightmares.

Psychological Treatment

In recent years, Barry Krakow and his colleagues at the University of New Mexico have conducted numerous studies regarding a promising psychological treatment for nightmares. This research group found positive results in applying this treatment to individuals suffering from nightmares in the context of PTSD. Krakow and colleagues found that crime victims and sexual assault survivors with PTSD who received this treatment showed fewer nightmares and better sleep quality after three group-treatment sessions. Another group of researchers applied the treatment to Vietnam combat veterans and found similarly promising results in a small pilot study.

The treatment studied at the University of New Mexico is called ‘Imagery Rehearsal Therapy’ and is classified as a cognitive-behavioral treatment. It does not involve the use of medications. In brief, the treatment involves helping the clients change the endings of their nightmares, while they are awake, so that the ending is no longer upsetting. The client is then instructed to rehearse the new, nonthreatening images associated with the changed dream. Imagery Rehearsal Therapy also typically involves other components designed to help clients with problems associated with nightmares, such as insomnia. For example, clients are taught basic strategies that may help them to improve the quality of their sleep, such as refraining from caffeine during the afternoon, having a consistent evening wind-down ritual, or refraining from watching TV in bed.

Psychologists who use cognitive-behavioral techniques may be familiar with Imagery Rehearsal Therapy, or may have access to research literature describing it.

Psychopharmacological Treatment

Researchers have also conducted studies of medications for the treatment of nightmares. However, it should be noted that the research findings in support of these treatments are more tentative than findings from studies of Imagery Rehearsal Therapy. Part of the reason for this is simply that fewer studies have been conducted with medications at this point in time. Also, the studies that have been conducted with medications have generally been small and have not included a comparison control group (that did not receive medication). This makes it difficult to know for sure whether the medication is responsible for reducing nightmares, or whether the patient’s belief or confidence that the medication will work was responsible for the positive changes (a.k.a., a placebo effect).

Some medications that have been studied for treatment of PTSD-related nightmares and may be effective in reducing nightmares include Topiramate, Prazosin, Nefazodone, Trazodone, and Gabapentin. Because medications typically have side effects, many patients choose to try a behavioral treatment first.

What happens if nightmares are left untreated?

Nightmares can be a chronic mental health problem for some individuals, but it is not yet clear why they plague some people and not others. One thing that is clear is that nightmares are common in the early phases after a traumatic experience. However, research suggests that most people who have PTSD symptoms (including nightmares) just after a trauma will recover without treatment. This typically occurs by about the third month after a trauma. However, if PTSD symptoms (including nightmares) have not decreased substantially by about the third month, these symptoms can become chronic. If you have been suffering from nightmares for more than 3 months, you are encouraged to contact a mental health professional and discuss with him or her the behavioral treatments described above.

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Mental health and the NHS

It’s estimated that around half the GP surgeries in England provide counselling services and support.
However, the availability of services varies depending on where you live and in some parts of the country, especially rural areas or small towns, NHS therapy is in short supply. You may have to wait a long time or travel to find something suitable.

The Improving Access to Psychological Therapies (IAPT) programme, which began in 2006, is putting thousands more trained therapists into general practices. The scheme will provide easy access to talking treatment on the NHS to everyone who needs it.

Your GP can refer you for talking treatment that is free on the NHS. This will usually be a short course of counselling or CBT from the general practice’s counselling service.
If counselling or CBT aren’t available at the surgery, your GP can refer you to a local counsellor or therapist for NHS treatment.
You may also be able to refer yourself for counselling. The IAPT programme means more and more primary care trusts (PCTs) are introducing the option of self-referral.
Self-referral means that people who prefer not to talk to their GP can go directly to a professional therapist. The service is already available in some parts of England. To find out what’s available in your area see our psychological therapy services directory.

If you have a serious mental health condition, such as severe depression, or a history of trauma or abuse, your GP can help you decide whether it would be better for you to see a different mental health professional, such as a clinical psychologist, psychotherapist, psychiatrist or a member of the local community mental health team.

If you can afford it, you can choose not to use the NHS and insted to pay for your therapy. The cost of talking therapy varies and a one-hour session can cost between £40 and £100! So in reality we are getting a SERIOUSLY good deal from the NHS… Other than the cost one of the drawbacks of going private is there are no rules governing who can dvertise talking therapy services, so it’s essential to check that the therapist is listed on one of the registers of approved practitioners. The advantage, however, is that you have more control over choosing a therapist as you can almost interview several until you find one who’s treatment suits you.

The main category of therapy offered by the NHS is talking therapy is a broad term. It covers all the psychological therapies that involve a person talking to a therapist about their problems. Howeverr, in some cases areas offer other forms, and it can also be possible to get funding towards a private therapist of a different type of therapy. Talking therapy includes cognitive behavioural therapy (CBT), cognative analitical therapy (CAT) and psychotherapy. Family therapy, couples therapy and group therapy are also offered, and can be placed under the umbrella term of talking therapy.

For those who find talking difficult creative therapies can aso be offered, these include such things as art therapy, body work, msic therapy and movement therapy.

We love the NHS… We currently are unable to work so get £360 a month to lie on, and as our rent alone is £575 that’s basically impossible… so without the NHS there is no way we could get treatment. In the past we have even had the hospitals, etc. send us and pay for taxi’s as we have issues getting outside and so couldn’t get there. I will admit that I have ad some bad experiances, bt these have mainly been with people rather than the service generally… and there are “bad” peopkle in every profession, doctors, nurses, psychs, etc are only human afterall. Over my life I have probably cost the NHS thousends of pounds (not exadurating either) and witout some of that treatment I would be dead… so without the NHS I’d either be dead or in so much debt that I’d wish i was dead…

Slip-ups are part of ED recovery

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Hi, I’m Rachel (hense the green lol – we all colour coded ourselves here


Anyway, I wanted to take part, to help. We have been thinking a lot on eating disorders recsntly, in part as Sarah is struggling with ED thoughts at the moment which is effecting all of us in a negative light what it comes to food.


We had a slight ED slip-up last week, but these ARE part of recovery, and I wish to explain why this is and how it’s all a case of  HOW you think or percieve it.


Instead of thinking about it as, “There goes all my hard work, screw it then, might as well eat and purge forever now!” think about it as what it was – A bump on the road to recovery.I mean noone said that the path to recovery was easy nor smooth

The all-or-nothing thinking of eating disorders can sabotage us in recovery, because it tells us that one slip-up immediately means we have failed. In reality, recovery is a process – a marathon and not a sprint.


So, you ate well for a week? So… 7 days, 3 meals a day. That means that you had 21 opportunities to fail, right? 21 chances to eat, then puke. …But you? You succeeded 20 of those times. 20 outta 21 ain’t bad.

In fact: *does math on calculator*… You’ve scored 95.3% on recovery!!!!!!!!!!!!!


That is nowhere near bad, nowhere near failing, nowhere near ground zero. Just get up where you fell down. No need to backtrack.

Rachel

Eye Movement Desensitization and Reprocessing

EMDR is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.

Basically, EMDR is a therapeutic technique in which the patient moves his or her eyes back and forth while concentrating on a problem or a traumatic memory. The therapist waves a stick or light in front of the patient and the patient is supposed to follow the moving stick or light with his or her eyes. The therapy was discovered by therapist Dr. Francine Shapiro while on a walk in the park.

Noone is really 100% sure of how EMDR actually works. A commonly proposed hypothesis is that dual attention stimulation elicits an orienting response. The orienting response is a natural response of interest and attention that is elicited when attention is drawn to a new stimulus.
Another theory is that humans naturally process memories and new informaion during REM sleep, but with traumatic memories this processing does not fully occur, leaving the memories unstored and still strongly connected to emotions and physical sensations. The idea here is that the eye movment in EMDR simulate REM sleep allowing the memory which is beng focused on to process.

However, there is a lot of empirical evidence for the effectiveness of EMDR, esspecially in the treatment of PTSD.

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