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2019 – Overcoming the Nightmares of Trauma

Planned Dream Intervention (PDI)

When diagnosing Post Traumatic Stress Disorder (PTSD), nightmares are one of the main criteria symp­toms and as such a very common feature and conse­quence of trauma experiences. Krakow & Neidhart (1992) define post-traumatic nightmares as ‘vivid re-cre­ations of painful events from the past.’ Havens et al (2018) makes the distinction that post-traumatic night­mares are not just bad dreams ‘but evoke very high lev­els of emotion and often feature severe bodily symp­toms such as sweating, shouting, fighting, and other gross body movements.’ Hasler and Germain (2009) estimated at least 90% of people who have a diagnosis of PTSD report nightmares related to traumatic events with a frequency that can be as often as six nights a week, and which may continue for 40-50 years after the original event.

Given how disturbing and intrusive nightmares can be for clients it is really encouraging that there is now a very straight forward pragmatic treatment approach to help people overcome their post-traumatic nightmares. It is known as the ‘Planned Dream Intervention’ (PDI) originally conceived by Dr Beverly Dexter in 2001 with excellent anecdotal results with U.S military veterans; but more recently Justin Havens et al (2018) has con­ducted a randomized control trial in UK with military veterans to evaluate the effectiveness of the approach compared to standard sleep hygiene and showed the PDI approach to have statistically significant results with improvements across all measures representing overall sleep quality, nightmares and trauma symptoms.

Planned Dream Intervention (PDI) can be taught in a sin­gle treatment session. Key steps are:

1. Understand that dreaming is a natural part of every­body’s sleep cycle which helps us to process our wor­ries of the day. Nightmares are ‘stuck dreams’ where processing has not been completed so it is like hav­ing a scary movie permanently stuck on the worst bit. Havens explains this using a washing machine met­aphor. The aim of the washing machine (brain) is to clean all the dirty washing (‘hot’ traumatic memories) so they are no longer disturbing. Repetitive night­mares that wake you up represent ‘stuck’ machine and leave washing dirty. The PDI is about kick start­ing the machine and getting to the end of the cycle with clean washing.
2. Have your client put themselves in the role as movie director. It is important that they oversee directing the movie and as such can use their imagination to make anything they want to happen.
3. The goal is not to rescript the whole of their night­mare, but to only focus on what is happening at the point of waking up. Ask, ‘what do I want to happen next that feels good and right at a gut level.’
4. Be as creative as you want using as many resources as you want so it can be surreal, violent, sexual, funny. You can introduce fantasy figures and reframe scenar­ios into something totally different. It’s important the client faces, rather than running away from their fear, and is triumphant – going From this …. To this ….

Examples are:

• A veteran had a nightmare of war and bloodshed. He was also a keen photographer, so he turned the war­ing soldiers into carrying large zoom lens cameras in­stead of guns and had them all on a photo-shoot.
• A client who was a survivor of childhood abuse had reoccurring nightmares of her father abusing her. She imagined herself as Katsa, a fantasy figure with a sword and dagger so she could stab him and cut off his head, throw it out of the window and walk away with her beloved protecting dog.
• Haven sites a case of a woman who had been raped and because of her nightmares was afraid to go to sleep. Using PDI she imagined the perpetrator was no longer on top of her but in front of her and she is Superwoman, strong and whacks him really hard so he flies off, smashing against a wall and is completely unconscious so he is no longer a threat to anyone and she is the heroine.
• When the client has their visualised script, ask what emotions they notice, and where do they sense this in their body. The emotional ‘volume’ of the PDI must equal that of the dream.
• The client should write down their script and read it before going to sleep.
• Practice, practice, practice.

PDI has unique advantages in that it can be applied when clients have ‘no clear dream recall, but have signif­icant bodily symptoms e.g. shouting, sweating, fighting. In addition, clients ‘do not need to talk explicitly about their trauma or nightmare content during the session.’

Lastly, Havens (2018) reports although PDI is not a cure for PTSD, it does have 80% success rate at stopping nightmares.

The counselling team here at Phoenix are pleased to support clients to gain the benefits of this approach.

SALLY WOODS SENIOR COUNSELLOR EMDR PRACTITIONER

References:

• Hasler, B., & Germain, A. (2009). Correlates and treatments of nightmares in adults. Sleep Medicine, 4(4), 507-517.doi:10.1016/j. jsmc.2009.07.012
• Haven, J., Hacker Hughes, J., McMaster, F., & Kingerlee, R. (2018). Planned dream interventions: A pragmatic randomized control trial to evaluate a psychological treatment for traumatic nightmares in UK military veterans. Military Behavioural Health 1-12. Taylor & Francis.doi 10.1080/21635781.1526148
• Krakow, M., & Neidhart, J. (1992). Conquering bad dreams and night­mares. New York: Berkley Books.

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