PLoS One
November 25, 2020
Gerlinde C. Harb, Jon‐Håkon Schultz
27 citations
Adolescents in the Gaza Strip who have lived through three wars and ongoing conflict report, on average, five nightmares per week for three years, with disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Nearly 60% of nightmares include the threat of death, and many contain surreal elements alongside realistic violence. Both students and teachers report impaired academic functioning and daytime sleepiness. Nightmare symptoms are associated with school functioning impairment. The authors suggest that increasing self-efficacy in relation to recurrent nightmares may be a useful intervention point for these traumatized youth.
Behavioral Sleep Medicine
January 15, 2025
Kristi E. Pruiksma, Katherine E Miller, Joanne L. Davis et al.
16 citations
An expert consensus panel reviewed treatment manuals for cognitive behavioral therapies for nightmares (CBT-N) tested in randomized clinical trials with adults. The panel developed guidelines for standardized implementation and terminology of CBT-N, addressing patient symptom presentations appropriate for treatment and components such as session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The recommendations aim to clarify confusion caused by unstandardized nomenclature and implementation nuances, and are intended to be revised as new research evidence emerges.
Nature and Science of Sleep
March 1, 2021
Jon‐Håkon Schultz, June Thorvaldsen Forsberg, Gerlinde C. Harb et al.
13 citations
Recurrent nightmares are common among children and adolescents living in conflict zones. In a study of 300 students aged 10-12 in the Gaza Strip, 56% reported recurrent nightmares, averaging 4.20 nights per week over 2.48 years. Among a larger sample of 1,093 treatment-seeking students aged 6-17, recurrent traumatic nightmares occurred on average 4.57 nights per week for 2.82 years. Self-reported academic functioning was negatively associated with experiencing nightmares, but not with nightmare frequency or intensity. The findings suggest that students in conflict-affected areas are particularly vulnerable and may benefit from screening and treatment for recurrent posttraumatic nightmares.
Frontiers in Sleep
January 8, 2026
Jon‐Håkon Schultz, June Forsberg, Eva Alisic et al.
1 citation
A school-based program called the Better Learning Program 3 (BLP), implemented in over 100 schools in Gaza from 2012 to 2017, significantly reduced recurrent nightmares among war- and conflict-exposed children and adolescents aged 6 to 17. In an open trial with 1,093 participants who reported nightmares an average of 4.86 nights per week, the 8-week intervention led to week-to-week reductions in nightmare frequency. After treatment, about half reported no nightmares, and another 47% had fewer nightmares. At a 10-month follow-up with 215 students, 42% remained free of nightmares, and another 42% had reduced nightmares to one or two per week. Booster sessions helped those who relapsed.
Dreaming : journal of the Association for the Study of Dreams
June 1, 2021
Katherine E Miller, Richard J Ross, Gerlinde C. Harb
Among 54 military veterans with posttraumatic stress disorder (PTSD) and recurrent nightmares, over half reported experiencing lucid dreaming—awareness during a dream that one is dreaming. Nearly all of those individuals specifically reported lucidity in nightmares. The lucid nightmare profile featured high awareness of dreaming but low control over dream content. Veterans described feeling stuck and anxious, and they tried unsuccessfully to awaken from these lucid nightmares. The findings suggest that lucid nightmares occur commonly in veterans with PTSD, with a profile similar to that previously reported for lucid dreaming experiences generally in this group.
Dreaming (New York, N.Y.)
June 1, 2021
K. Miller, R. Ross, Gerlinde C. Harb
Among military veterans with PTSD and recurrent nightmares, over half reported experiencing lucid dreaming, and nearly all of those reported lucidity specifically during nightmares. The lucid nightmare profile involved high awareness of dreaming but low ability to control dream content. Veterans described feeling stuck and anxious, and they tried unsuccessfully to wake themselves from these lucid nightmares. The pattern matches the general lucid dreaming profile previously observed in this group.
Journal of Traumatic Stress
October 1, 2012
Gerlinde C. Harb, Richard Thompson, Richard J Ross et al.
The nightmares of 48 male U.S. Vietnam war veterans with combat-related PTSD were predominantly replays of actual combat events involving death, violence, and fear for one's life. In Imagery Rehearsal therapy, rescripted dreams that addressed or resolved the nightmare theme were linked to reduced sleep disturbance, but including violent details in the rescripted dream predicted poorer treatment outcome in nightmare frequency (B = 5.69, SE = 1.14). Experiencing olfactory sensations in nightmares, a possible marker of nightmare intensity, also predicted poorer treatment response (B = 2.95, SE = 1.06). The therapy may be most effective when rescripted dreams resolve the nightmare theme and exclude violent content.