Bruce Dow, M.D.

Cognitive Dissonance, PTSD, and Control

Cognitive dissonance, first described in 1956 by Festinger, is a psychological state in which one holds two conflicting beliefs at the same time.  Most people are uncomfortable in this state of mind, and try to reduce the conflict, sometimes successfully, sometimes not.

A famous example of cognitive dissonance can be found in Aesop’s fable of The Fox and the Grapes.  The fox wants to eat the grapes, but finds them to be out of reach.  He resolves his dilemma by concluding that they are probably not very tasty, perhaps sour or unripe (“sour grapes”).  When we can’t obtain something, we tend to criticize it, which reduces our cognitive dissonance.

People suffering from posttraumatic stress disorder (PTSD) often experience cognitive dissonance, which will not go away, thereby maintaining their illness.  One example is the stalwart and respectable citizen, haunted by a moment of cowardice in a dangerous situation.  Another example is the war hero, haunted as a veteran by atrocities committed in a combat setting.  A third example is the child molestation survivor, haunted as an adult by the thought that she may have enjoyed or encouraged the sexual assault.

Effective treatment for PTSD seeks to remove cognitive dissonance in one way or another.  The therapist helps the PTSD sufferer “reframe” the trauma situation so as to understand it in a new way.  In dream revision therapy, the cognitive conflict can often be reduced or eliminated without directly addressing the original trauma that created it.  Dream revision therapy is pragmatic and practical rather than probing or introspective.  If there is a problem in the nightmare, one looks for a solution to it.  No need to be concerned about how or why the problem originated.

This pragmatic aspect of dream revision therapy makes it easier for PTSD sufferers to use it on their own.  Once they learn the method, they do not need a therapist to help them.  They can come up with a revised dream on their own, and simply try it out the next time they go to sleep.  If one attempted revision doesn’t work, they can try others until they find a more suitable one.

The goal in dream revision therapy is control over nightmares related to the trauma.  Control inevitably involves the resolution of conflicting ideas or emotions.  Control over trauma-related nightmares results in control over the trauma, which leads to control over one’s current waking life.  In this way, dream revision therapy leads to recovery from PTSD.