Rescripting Recurrent Nightmares and Recovering from PTSD
Severe life-threatening traumatic events can lead to a syndrome known as posttraumatic stress disorder (PTSD) including recurrent nightmares, vivid flashbacks, avoidant behaviors, memory deficits, feelings of detachment, excessive vigilance, and exaggerated startle responses. Recurrent nightmares appear to be important in maintaining the syndrome. An effective treatment for PTSD involves changing the ending of each recurrent nightmare while awake, and rehearsing the changed version before falling asleep. With well-chosen modifications, nightmare frequency and intensity gradually diminish until the nightmare disappears. Once posttraumatic nightmares disappear, other PTSD symptoms go away as well. The method works for long-standing as well as recent onset PTSD.
Posttraumatic Stress Disorder: Brain Mechanisms
Severe, life-threatening traumatic events can lead to posttraumatic stress disorder (PTSD). PTSD is a syndrome characterized by recurrent nightmares, vivid flashbacks, avoidant behaviors, memory deficits, feelings of detachment, excessive vigilance, and exaggerated startle responses. The anterior-medial region of the prefrontal cortex helps to regulate the amygdala, a brain stem region that processes such basic emotions as anger, fear, guilt, shame, and sadness. In patients with PTSD (compared with normal subjects) the anterior-medial prefrontal cortex (AMPC) shows reduced activity and the amygdala shows increased activity. Effective treatment for PTSD can either suppress the overactive amygdala or enhance the underactive AMPC. Prazosin (an antihypertensive drug) reduces nightmares by reducing norepinephrine input to the amygdala. Dream revision psychotherapy reduces nightmares by activating the AMPC: teaching the PTSD sufferer to feel like a survivor rather than a victim.
Normal Sleep and Dreaming: Brain Mechanisms
Under normal conditions adult human subjects sleep six to eight hours per night. Normal sleep involves a series of four to six cycles of about ninety minutes duration. Each cycle ends with a dream lasting ten to thirty minutes; the dreams become progressively longer and more complex over the night. We have four to six dreams per night of sleep. Dreaming involves the hippocampus of the brain, an important memory center, as well as other centers such as the amygdala, basal ganglia, and several regions of the cerebral cortex (parietal, temporal, prefrontal). The process of dreaming involves the consolidation (creation) of new memories from events that have occurred recently in our lives. Emotional memories appear to be stored in the posterior-medial prefrontal cortex (PMPC). Dreams involve the juxtaposition of old and new memories dealing with the same or similar emotions.
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