Temporal associations between nightmares and PTSD symptoms in the acute post-sexual assault period: An ecological momentary assessment study
Ashby Boland, Lauren D Reyes, Jenny Black, Karen Serrano, Samuel A. McLean, Nicole A. Short
Journal of Mood and Anxiety Disorders July 10, 2026 DOI: 10.1016/j.xjmad.2026.100191 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 54 |
| Population | Women sexual assault survivors presenting for emergency care |
| Duration | 6-week follow-up with daily EMA surveys |
| Topics | Dreaming PTSD |
| Keywords | Ecological validity Ecological study Poison control Disease Ecology |
| Key findings | Within-person associations between nightmares and PTSD symptoms were not significant after adjusting for autoregressive effects, but between-person associations showed that individuals with frequent nightmares had higher PTSD symptoms. |
Abstract
Nightmares are common after sexual assault and may play an important role in the development of posttraumatic stress disorder (PTSD). However, little research has examined daily temporal associations between nightmares and PTSD symptoms in the acute aftermath of sexual assault. Ecological momentary assessment (EMA) was used to test within- and between-person associations between nightmares and PTSD symptoms during the six weeks following assault. Participants were 54 women sexual assault survivors presenting for emergency care ( Mage =24.64, 51.9% White, 29.6% Hispanic/Latina), followed with daily EMA surveys. Dynamic structural equation modeling (DSEM) was used to estimate lagged bidirectional associations between nightmares and PTSD symptoms. Most participants had clinically significant PTSD symptoms according to traditional self-report (97.9% at week one; 85.4% at week seven) and frequent nightmares measured by EMA (42.8% of days). At the within-person level, nightmares significantly predicted next-survey PTSD symptoms (the full model accounted for 18.4% of the within-level variance in PTSD), and PTSD symptoms significantly predicted subsequent nightmares (the full model accounted for 11.7% of the within-level variance in nightmares). However, these effects were no longer significant after adjusting for autoregressive effects. At the between-person level, individuals with frequent nightmares had higher PTSD symptoms and vice versa, with models accounting for 43.2-43.9% of the between-level variance. While nightmares are common in early recovery, short-term fluctuations in nightmare symptoms may not meaningfully drive PTSD symptoms changes once stability is considered. Nightmares may function as an indicator of overall PTSD severity, underscoring their importance in identifying survivors at risk for more severe PTSD symptoms.
Comparable studies
Other observational and cohort studies on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault | 2008 | Observational cohort | n = 6 |
| An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... | 2017 | Observational study using ambulatory polysomnography | n = 35 |
| Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares | 2004 | Observational cohort | n = 44 |
| Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs | 2001 | Observational study | |
| Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD | 2018 | Retrospective review | n = 37 |
Citations in the library
Cites 9
- An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Sleep November 21, 2017
- Nightmares share genetic risk factors with sleep and psychiatric traits Translational Psychiatry February 27, 2024
- The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder European Journal of Trauma & Dissociation June 30, 2023
- Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation. Journal of Clinical Sleep Medicine September 1, 2025
- Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms European Journal of Psychotraumatology October 8, 2024
and 4 more in the library