Bruce Dow, M.D.

Nightmares and Waking Life

Nightmares (during sleep) and flashbacks (during waking) are the hallmarks of PTSD.  Some people with PTSD are more troubled by nightmares, others by flashbacks.  Many people with PTSD are troubled by both.  Daytime “triggers” can create daytime flashbacks, which are then followed by nightmares at night.

The reason PTSD is such a problem is that the person with PTSD keeps getting sucked back into the trauma, despite its ceaseless retreat into the past.  The further the trauma retreats into the past, the more disruptive for the PTSD sufferer to reexperience it.

One useful way to think about dream revision therapy is that we are fighting off the flashbacks and nightmares by injecting bits and pieces of current waking life experience into them.  PTSD threatens to bring the past into the present (as a nightmare).  Effective dream revision brings details from the present into the earlier nightmarish event.  By conducting dream revision therapy, we do battle with PTSD; we engage it, using its own tricks.

How do we bring the present into the past?  One way is to make use of modern technology; we create deliberate anachronisms.  For example, in a nightmare from 20 years ago we introduce cell phones, text messaging, social media, flash mobs to call for help.  We use GPS to report where we are.  We use advanced high-tech helicopters for rescue. We use pepper spray against assailants.  We hop onto a train, boat, or airplane.  We get a giant crane to lift up an obstacle.  Effective dream revision requires an active imagination.  We do whatever it takes to get ourselves out of the rut that the PTSD nightmare has created.

Dream revision doesn’t always happen in one step.  Often there are a series of steps leading from one dream to the next until the nightmare goes away.  An encouraging sign is when dream revision therapy leads to a new dream containing elements from the present.  Any encroachment of the present into a PTSD nightmare from the past is a victory.  In subsequent dream revisions we can build on small encroachments to create larger and larger ones until the nightmare finally dissolves away.

Skeptics sometimes complain that dream revision is just wallpaper, covering over actual traumatic events with pretty pictures, while the trauma remains underneath.  However, our brain doesn’t seem to work that way.  The pretty picture becomes the new reality.  The old reality of the trauma begins to fade away.  “What you see is what you get.”  By changing the subject, as it were, dream revision helps people get unstuck from the trauma that has trapped them in the past.  A better analogy is changing the channel on your TV.  Dream revision is simply changing from the horror channel to something more pleasant.  Who can argue against that?