Bruce Dow, M.D.

Dream Revision Therapy and Lucid Dreaming

I recently finished Robert Waggoner’s book, Lucid Dreaming (2009), a fascinating read.  Here I highlight similarities and differences between dream revision therapy and lucid dreaming.

Lucid dreaming is the state of being conscious while dreaming.  The fact of being conscious gives you (the dreamer) the potential capacity to make decisions from within your dream: whether to turn right or left, or possibly to fly.  To maintain yourself in a lucid state while dreaming, according to Waggoner, you must stay “aware” and not get lost in the details of the dream.  He points out that this awareness is analogous to “mindfulness” in the waking state.  During both dream lucidity and waking mindfulness you are an active observer of your emotional and physical state.  You stand back from your emotions rather than getting caught up in them.  Achieving this observer state requires practice and discipline in the lucid dreamer, just as in the person seeking mindfulness while awake.

Lucid dreaming is not easy to achieve. Waggoner, an experienced lucid dreamer (30+ years and counting), says he has about 3 lucid dreams per month, out of about 90 recalled dreams, which amounts to less than 4%.  He does admit he had up to 30 lucid dreams per month as a young man during his college years.

Lucid dreaming might be difficult to achieve in someone suffering from PTSD, as the nightmare could draw you into the dream and block your awareness of dreaming.  Mindfulness might also be difficult for PTSD sufferers to achieve during wakefulness, for the same reason.  The strong emotions associated with flashbacks could pull you in, thereby blocking your mindful detachment.

Dream revision therapy is used mostly with recurrent nightmares, which are predictable, thus allowing them to be changed while fully awake.  If you fall asleep with a revised dream having been well rehearsed, there is a good chance the recurrent nightmare will be changed in some way or even eliminated.  Any substantial change in a recurrent posttraumatic nightmare is welcome, since it means that the nightmare has been impacted by dream revision.  If you keep working to change the nightmare even further, it will eventually weaken and go away.

In doing dream revision therapy it is almost as if you are a lucid dreamer, though you are not.  You have simply “incubated” a dream change; that is, you have put the idea of a dream change into your head.  Since the brain normally revises stressful dreams as part of the process of recovering from stress (see below), you have simply facilitated a normal function of the dreaming brain.

Once you become adept at dream revision, you will be able to change, and then eliminate, any recurrent nightmare that comes along.  In the process, you might even become a lucid dreamer, especially if your PTSD symptoms go away, and you are able to maintain awareness in your dreams, as Waggoner describes.

There are critics of both lucid dreaming and dream revision therapy.  These critics argue that dreams are sacrosanct, and should not be altered.  Advocates of psychoanalytic therapy (psychoanalysis), including both Freudians and Jungians, believe that dreams are the “royal road to the unconscious”, to be analyzed and interpreted but otherwise left alone.

Dream revision therapy is a form of cognitive therapy.  Aaron Beck, a psychoanalyst and psychiatry professor at the University of Pennsylvania, noted in the late 1950’s that the thoughts (and dreams) of depressed patients were illogical, i.e., distorted, exaggerated, even masochistic.  We would now say “psychotic” for some thoughts (i.e., “I’m hopeless, helpless, worthless”) that occur in the presence of severe depression.  Beck and his colleagues developed cognitive therapy in the 1960’s and 70’s, initially for depression, later for anxiety disorders (including PTSD).

By the time of Beck’s initial work (around 1960) psychotropic medications for depression were already available.  It was perhaps natural for him to think of changing his patients’ illogical thoughts rather than simply identifying and analyzing them according to traditional psychoanalytic principles.  Beck and colleagues developed cognitive therapy as a kind of confrontational dialogue between therapist and patient over the patient’s dysfunctional thoughts, with the goal of helping him/her gain insight into — and thereby change — them.

Dream revision therapy for posttraumatic nightmares is an extension, into the imagery domain, of the basic concepts of cognitive therapy.  Barry Krakow and his colleagues at the University of New Mexico, beginning in the early 1990’s, described a form of dream revision therapy they called “imagery rehearsal therapy” (IRT).  In the sense that IRT or dream revision therapy attempts to change a dream, it is not psychoanalytical (i.e., neither Freudian nor Jungian), but anti-psychoanalytical.  The goal in dream revision therapy is not to study a posttraumatic nightmare, but to eliminate it.

Dream revision therapy for PTSD attempts to change recurrent nightmares, and eventually erase them, because nightmares are toxic.  Untreated PTSD does not improve over time, but gets worse and worse.  The closest medical analogy may be an obstruction: bowel obstruction, kidney stone (blocking a ureter), occluded blood vessel (deep vein thrombosis, heart attack, stroke).  Medical doctors, in treating such physical obstructions, don’t keep observing and analyzing them.  They take action to fix the blockage, and to prevent future blockages of a similar nature.  As therapists and self therapists we need to do the same with recurrent nightmares; we need to end them.

Dream revision therapy and lucid dreaming are different in many ways, but similar in one way: they are both active.  Each asserts that dreaming, while seemingly reactive (i.e., passive), can be an active process.  In fact, dream revision following trauma or stress occurs normally within the brain, as mentioned by Calvin Hall and Robert van de Castle in their influential book, The Content Analysis of Dreams (1966), and confirmed by my patients’ and my own personal dreaming experiences.

Waggoner refers to Hall and van de Castle’s book in defending his use of lucid dreaming to alter his own dreams.  He sees the lucid dreamer as a sailor on the sea, tacking back and forth in different directions as he/she chooses.  The sailor is actively sailing rather than passively floating, but the sailor cannot control the sea. Waggoner says his goal as lucid dreamer is not so much to change dreams as to challenge or tweak them here and there, to gain deeper understanding of the normal process of dreaming.

In dream revision therapy (aka, imagery rehearsal therapy or IRT) we are trying to change dreams, though we can’t control the sea either.  Making use of the wind, like a sailor, we can change direction and thereby arrive at a new destination.