Journal of Sleep Research
January 29, 2019
Annika Gieselmann, Malik Ait Aoudia, Michelle Carr et al.
192 citations
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.
Dreaming
June 1, 2006
Brigitte Holzinger, Stephen LaBerge, Lynne Levitan
69 citations
In lucid dreams, where dreamers are aware they are dreaming, brain activity in the beta-1 frequency band (13–19 Hz) is higher in both parietal regions compared to nonlucid REM sleep. The ratio of frontal to parietal beta-1 activity shifts from 1 to 1.16 in nonlucid dreams to 1 to 1.77 in lucid dreams. The greatest increase tends to occur in the left parietal lobe (P3), an area linked to semantic understanding and self-awareness. Seven men and four women experienced in lucid dreaming were recorded over two nights, with lucidity confirmed by dream reports and eye-movement signals in response to light stimuli.
Acta Neurologica Scandinavica
January 30, 2015
Brigitte Holzinger, Gerhard Klösch, B. Saletu
59 citations
Adding lucid dreaming training to Gestalt therapy reduces nightmare frequency more quickly and to a greater extent than Gestalt therapy alone. Thirty-two people who had nightmares at least twice a week were randomly assigned to ten weeks of either Gestalt therapy alone or Gestalt therapy plus lucid dreaming instruction. Both groups reported significantly fewer nightmares after treatment and at a three-month follow-up. Only the group receiving Gestalt therapy alone showed a significant drop in dream recall frequency. Sleep quality improved significantly for both groups at follow-up, but only the lucid dreaming group showed significant improvement immediately after therapy ended.
Frontiers in Psychology
January 1, 2020
Brigitte Holzinger, Bernd Saletu, Gerhard Klösch
30 citations
Lucid dreaming therapy (LDT) did not improve sleep quality or reduce nightmare severity in patients with posttraumatic stress disorder (PTSD), but it significantly decreased levels of anxiety and depression. About 80% of PTSD patients suffer from nightmares or dysphoric dreams. LDT teaches dreamers to become aware of and control dream content, offering a potential alternative or complementary treatment for PTSD-related anxiety and depression, even though it had no effect on sleep variables or the PTSD profile measured by the Impact of Events Scale.
heiDOK (Heidelberg University)
January 1, 2009
Evelyn Doll, Georg Gittler, Brigitte Holzinger
27 citations
People who frequently experience lucid dreams—dreams in which the dreamer knows they are dreaming while the dream continues—tend to score higher on measures of mental health, freedom from complaints, expansivity, autonomy, and self-esteem compared to rare or non-lucid dreamers. This conclusion comes from a study of 89 subjects, divided into frequent (27), rare (33), and non-lucid (29) dreamers. However, no significant differences were found between the groups in behavioral control, decision behavior, or spatial abilities.
Nature and Science of Sleep
August 1, 2022
Brigitte Holzinger, Franziska Nierwetberg, Frances Chung et al.
16 citations
High nightmare frequency (≥1–2 nights/week) rose from 13.24% to 22.35% during the COVID-19 pandemic. Factors associated with high nightmare frequency included self-reported post-traumatic stress symptoms (OR=2.11), other mental disorders, sleep problems, financial burden, confinement, having had COVID-19, and work situation. Post-traumatic stress symptoms partly mediated the relationship between pandemic-related stressors and nightmare frequency. The authors conclude that the pandemic caused traumatization in a substantial proportion of society and suggest that health care workers screen for nightmares as an indicator of post-traumatic stress symptoms and other disorders.
Frontiers in Psychology
January 1, 2020
Brigitte Holzinger, Lucille Mayer
15 citations
Lucid dreaming is a state where dreamers know they are dreaming and can deliberately control the dream's content. This study examined seven awareness criteria of lucid dreaming, originally proposed by Paul Tholey, and mapped each to its underlying brain circuits. The results showed that multiple brain regions are involved, and during lucid dreaming a coordinated brain network emerges that is more than the sum of its parts. The findings suggest that lucid dreaming involves a distributed neural network rather than a single area, though further research is needed to fully understand the neurological basis.
Journal of Clinical Medicine
May 12, 2023
Severin Ableidinger, Brigitte Holzinger
13 citations
Sleep paralysis and lucid dreams are both connected to REM sleep but differ in emotional tone and perceived controllability. A review of 10 studies, mostly surveys plus a case study, a randomized trial, and an EEG study, found positive and significant correlations between sleep paralysis and lucid dreaming in most of the studies, indicating a connection between the two states. Research remains limited and methodologically diverse, and future work should develop standardized methods for examining both phenomena.
Frontiers in Psychology
January 1, 2021
Brigitte Holzinger, Franziska Nierwetberg, Gerhard Klösch
2 citations
A woman with severe PTSD and recurrent nightmares completed six weeks of lucid dreaming training, which enabled her to alter her dream plots and improve several psychological measures. Her dream reports and assessment results are presented. The authors argue that sleep and nightmares should receive more attention in psychiatric treatment, not only for PTSD patients, and support their case with literature on non-medication treatments for sleep problems.
Somnologie - Schlafforschung und Schlafmedizin
August 15, 2023
Severin Ableidinger, Gerhard Klösch, Brigitte Holzinger
Dream research faces challenges due to limited, unstandardized, or labor-intensive questionnaires, leading to divergent results and poor comparability. The Dreamland Questionnaire, developed in 1997 and subsequently revised and partially validated, offers a short, easy-to-use tool covering dream quantities, qualities, and lucidity, and encourages dreamers to write down their dreams. It has been used to show that dreams collected in the laboratory differ from those at home, and that emotionality ratings differ between dreamers and external raters. The questionnaire is available in German.
Journal of Sleep Research
April 1, 2026
Severin Ableidinger, Luigi De Gennaro, Sérgio Mota-Rolim et al.
During the COVID-19 pandemic, about 30% of people frequently knew they were dreaming (lucid dreaming), and roughly half of those (17%) could influence their dreams (lucid dreaming with agency). Female gender and anxiety symptoms were linked to less ability to influence dreams, while dream recall, nightmares, insomnia, dream enactment behavior, sleep vocalization, short and long COVID, and PTSD were linked to more ability. Older age, dream recall, nightmares, and anxiety were linked to lucid dreaming without agency, while short sleep, being an evening type, and short COVID were linked to less of it. The different patterns suggest lucid dreaming with and without agency may be distinct sleep states, and this is the first study showing COVID-19 and long COVID are associated with lucid dreaming.
Journal of Sleep Research
February 1, 2026
Courtney J Bolstad, Bjørn Bjorvatn, Ngan Yin Chan et al.
In a large multi-country survey of 15,854 adults, frequent dream recall (at least weekly) was reported by 54.0% of participants in 2021 and 51.1% in 2019. Frequent nightmares rose from 6.9% in 2019 to 11.0% in 2021, suggesting an increase during the COVID-19 pandemic. Dream recall showed a linear relationship with sleep duration, while nightmare frequency had a quadratic relationship. Prevalence rates varied by age, gender, and country. This is the first multi-continent study to provide these prevalence estimates across 16 countries, including some never studied before.
Journal of Sleep Research
October 1, 2024
Courtney J Bolstad, Brigitte Holzinger, Serena Scarpelli et al.
During the COVID-19 pandemic, suicidal ideation was 2% lower overall than before, while nightmare frequency increased by 4.50%. Data from 9328 individuals across 16 countries showed that suicidal ideation decreased significantly in Austria, Sweden, and Bulgaria but rose non-significantly in Italy and Portugal. Participants with long-COVID reported higher rates of suicidal ideation (21.10%) than those with short-COVID (12.40%), though ideation did not differ by COVID-19 history alone. Nightmare frequency was higher in those with prior COVID-19 (14.50% vs. 10.70%), during active infection (23.00% vs. 8.10%), and in long-COVID (18.00% vs. 8.50%). Frequent nightmares during the pandemic increased the odds of suicidal ideation (OR = 1.
Nature and Science of Sleep
January 1, 2022
Serena Scarpelli, Michael R Nadorff, Bjørn Bjorvatn et al.
People reported more dream activity during the pandemic than before it. Those who had COVID-19 reported significantly more nightmares during the pandemic than matched controls who had not had COVID-19, while dream recall frequency did not differ between the groups. COVID-19 participants also had higher anxiety, depression, and PTSD symptom scores, and lower quality of life and well-being scores than controls. Nightmare frequency was predicted by dream recall frequency, PTSD, anxiety, insomnia, COVID-19 severity, sleep duration, and age. The findings suggest that the more severely people were affected by COVID-19, the greater the impact on dream activity and quality of life.
Somnologie : Schlafforschung und Schlafmedizin = Somnology : sleep research and sleep medicine
January 1, 2022
Severin Ableidinger, Franziska Nierwetberg, Brigitte Holzinger
During the COVID-19 pandemic, people began remembering more dreams, and dream content shifted toward themes such as sickness, confinement, and bugs, especially in the English-speaking world. Nightmare frequency also increased. Factors contributing to this change include more time spent in REM sleep due to increased sleep duration, which can produce bizarre and vivid dreams, and stress or poor mental health that reduced sleep quality, which can also boost dream recall. Dreams help regulate mood, so the rise in dreams and altered content may reflect a reaction to rising stress and declining mental health. As the pandemic progressed, further changes in mental health, dream recall, and dream content emerged, though data remain scarce.
Nature and Science of Sleep
January 1, 2021
Eirin Fränkl, Serena Scarpelli, Michael R Nadorff et al.
Dream recall frequency increased during the COVID-19 pandemic compared to pre-pandemic levels across four continents. In a cross-sectional web survey of 19,355 individuals from 14 countries, high dream recall (three or more nights per week) was associated with female gender, nightmares, sleep talking, sleep maintenance problems, symptoms of REM sleep behavior disorder, and repeated disturbing thoughts indicative of PTSD. Older adults aged 55-64 reported less high dream recall than younger participants. While unadjusted analyses showed associations between depression, anxiety, and dream recall, adjusted analyses revealed negative associations: depression and anxiety were linked to lower odds of high dream recall. The findings suggest that the pandemic's emotional intensity is reflected in dreams.
Frontiers in Psychology
January 1, 2020
Brigitte Holzinger, Lucille Mayer, Isabel Barros et al.
The Dreamland Questionnaire (DL-Q), a new instrument for analyzing dream content, was validated against the established Hall and van de Castle Coding System (HVDC). Twenty-two participants provided written dream reports and completed the DL-Q, yielding 30 dreams for comparison. Correlations between the two measures were high for dominant characters, pleasantness of dream content, and body-related experiences. Some DL-Q items showed low correlations, and others could not be directly compared because the HVDC lacked equivalent items. The DL-Q demonstrates satisfactory validity and reliability for assessing dream criteria and may serve as a useful tool for clinical and research purposes, though further validation is needed for certain items.
Contemporary Hypnosis
December 1, 2009
Brigitte Holzinger
The concept of lucid dreaming was first named by Dutch psychiatrist Frederik Willems van Eeden in 1913, though descriptions of the phenomenon appear in Aristotle's writings. Modern research began in 1980 when LaBerge introduced a method for physiological investigation using eye signals. Current efforts aim to define the neurophysiological correlates of lucid dreaming, a goal not yet achieved. One application is in psychotherapy, mainly for treating nightmares, but other therapeutic potentials remain undiscovered and offer opportunities for future research.