Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies.
Bryony Sheaves, Stephanie Rek, Daniel K. Freeman
Clinical Psychology Review December 17, 2022 DOI: 10.1016/j.cpr.2022.102241 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Longitudinal Peer reviewed |
|---|---|
| Topics | Anxiety Depression PTSD Dreaming |
| Keywords | Humans Dreams Anxiety disorders Stress disorders, post-traumatic Suicidal ideation Suicide Psychosis Nightmares |
| Key findings | The authors argue that the limited literature suggests treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia; nightmares increased risk of later suicide outcomes, though two small pilot trials indicated treating nightmares might potentially prevent recovery of suicidal ideation. |
Abstract
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
Comparable studies
Other systematic reviews and meta-analyses on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. | 2013 | Systematic review with meta-analytic comparison | |
| Lucid dreaming incidence: A quality effects meta-analysis of 50 years of research | 2016 | Meta-analysis | |
| The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. Adults with chronic and recurring nightmares | 2023 | Systematic review | |
| The relationships between insomnia, nightmares, and dreams: A systematic review Individuals without a concomitant psychopathology, including those with insomnia or... | 2024 | Systematic review | |
| Psychosocial treatments for nightmares in adults and children: a systematic review | 2023 | Systematic review |
Citations in the library
Cited by 26
- Bad dream, nightmares and psychopathology: a systematic review Frontiers in Psychiatry October 8, 2024
- Evaluating the Relationship Between Emotion Regulation, Mood and Distressing Dreams Using Daily Sleep Diary Reports in Trauma Survivors Journal of Sleep Research April 3, 2025
- Understanding and Treating Nightmares: A Comprehensive Review of Psychosocial Strategies for Adults and Children. Cureus September 1, 2024
- Clinical nightmare frequency and its association with reduced physical health during military operations Sleep August 26, 2023
- Haunted by Nightmares: Factors Associated with Nightmare Frequency and Experiences Psychology 2025
and 21 more in the library
Cites 24
- Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Sleep 2002
- Prevalence of Nightmare Disorder in Psychiatric Outpatients Psychotherapy and Psychosomatics 2013
- Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms The Canadian Journal of Psychiatry August 1, 2015
- Childhood sleep disturbance and risk of psychotic experiences at 18: UK birth cohort The British Journal of Psychiatry May 8, 2015
- Nightmares in the general population: identifying potential causal factors Social Psychiatry and Psychiatric Epidemiology July 15, 2017
and 19 more in the library