July 27, 2012

Hansel and Gretel kids drawingIn an earlier blog post (Two New Treatments for PTSD) I indicated that dream revision is a new treatment for PTSD.  What I meant by this is that it is not currently recognized as a firstline method for treating PTSD, and should be.  Prolonged exposure (Edna Foa and colleagues), eye movement desensitization and reprocessing (Francine Shapiro and colleagues) and cognitive processing (Patricia Resick and colleagues) are more widely used at the present time.

A reader of my earlier blog commented, quite rightly, that dream revision has been used for many years by adults helping to sooth children with recurrent nightmares about monsters and the like.  Children’s fairy tales may have developed over the years for this purpose, as described by Bruno Bettelheim in The Uses of Enchantment (1975).  There are reports of the use of dream revision for children even in the hunter-gatherer Senoi people of Western Malaysia, as analyzed and critiqued by William Domhoff in The Mystique of Dreams (1985).  Denyse Beaudet’s book, Encountering the Monster (1990) also discusses the Senoi in the course of her presentation of a series of monster dreams in children.

My use of dream revision is restricted to adults suffering from posttraumatic stress disorder (PTSD).  Barry Krakow and colleagues in Albuquerque, NM (2001) and David Forbes and colleagues in Australia (2003) have published studies of imagery rehearsal therapy (IRT) involving dream revision in adults with PTSD.  Clearly the method did not originate with me.  My goal is not to take credit for this ancient technique, but to share my own experiences of helping PTSD sufferers recover with the use of the method.

Among the estimated 2.5 million US veterans of the Iraq and Afghanistan Wars, as many as 20% (500,000) may have developed PTSD.  Within the general population of the US (300 million), an estimated 22.5 million people (10% of women, 5% of men) are expected to experience PTSD in their lifetimes.  These are enormous numbers, and we need to utilize all effective treatments as urgently as possible.

Dream revision is a four step process: 1) create a narrative version of the dream (or a drawing); 2) revise (rescript, redraw) the dream so it has a happy or at least satisfying outcome; 3) memorize the revised version; 4) go to sleep and see what happens.

The process may need to be repeated a few (or more) times until the nightmare goes away.  Essentially, one is actively engaging the nightmare, not running away from it.  The dream may change several times, or not change at all, until it finally goes away.  One needs to be persistent.

An example of (possible) dream revision from the fairy tale literature is the story of Hansel and Gretel (from the Brothers Grimm).  Instead of being cooked in the oven and eaten by the wicked witch, the resourceful Gretel manages to lure the witch into the oven, shut and bolt the door, and then listen to the witch’s screams “as she burns to death miserably” (The Juniper Tree, 1971, translated by Lore Segal, pictures by Maurice Sendak).  Revenge is not required for effective dream revision, but it is allowed.