Chronic nightmares arise from an interaction between elevated hyperarousal and impaired fear extinction, facilitated by trait affect distress from traumatic experiences, early childhood adversity, trait susceptibility, elevated thought suppression, and potentially sleep-disordered breathing. Treatment options target nightmare meaning, chronic repetition, or maladaptive beliefs. The paper reviews epidemiological findings, aetiology models for traumatized and non-traumatized individuals, and evidence-based interventions, noting gaps in healthcare provider knowledge and delivery. Future perspectives for nightmare treatment and aetiology research are outlined.
People who have nightmares in which they are the aggressor may be more aggressive in waking life, supporting the continuity hypothesis that dreams reflect waking experiences. In contrast, nightmares where the dreamer reacts aggressively in self-defense may compensate for suppressed aggression in waking life. The study used the Buss and Perry Aggression Questionnaire to measure waking-life aggression. Results showed that dreamers who initiated aggression in their nightmares were more aggressive in waking life than those whose aggression was reactive to threats from other dream characters. This suggests two subtypes of aggressor nightmares: those reflecting continuity of waking aggression and those compensating for it.
Internet-based imagery rehearsal therapy (IRT) reduces nightmare frequency and distress in patients with mostly idiopathic nightmares. IRT outperformed a nightmare frequency control condition on both outcomes. Compared to a narrative control group, IRT was superior only for nightmare distress, not frequency, because describing the nightmare narrative in detail also lowered frequency. Guidance by a nightmare coach did not affect efficacy, compliance, or dropout. IRT appears effective even with minimal guidance.