Ross Levin

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion.

The Relation Between Cognitive Functioning and Self-Reported Sleep Complaints in Nondemented Older Adults: Results From the Bronx Aging Study

Abstract Self-reported sleep complaints and current cognitive functioning were assessed in 375 nondemented participants ages 75 to 85 years (134 men and 241 women) as part of enrollment in the Bronx aging study, an ongoing longitudinal community-based study of cognitive aging. This study only reports on the baseline data collected from 1980 to 1983. Sleep complaints were common, occurring in about 25% of the sample. Furthermore, after controlling for depression, use of hypnotic medication, physical morbidity, age, and education, participants who reported longer sleep onset latencies performed significantly worse on measures of verbal knowledge, long-term memory and fund of information, and visuospatial reasoning. Participants who reported longer sleep durations did significantly worse on a measure of verbal short-term memory. These results suggest that perceived sleep is related to select objective cognitive abilities even when accounting for commonly recognized mediating variables, such as depression, medical comorbidity, age, or use of hypnotic medication. Given the restricted range of this nondemented sample, these results may underestimate the relation between cognitive abilities and sleep.

Nightmares, Bad Dreams, and Emotion Dysregulation: A Review and New Neurocognitive Model of Dreaming

Nightmares—vivid, emotionally dysphoric dreams—are quite common and are associated with a broad range of psychiatric conditions. However, the origin of such dreams remains largely unexplained, and there have been no attempts to reconcile repetitive traumatic nightmares with nontraumatic nightmares, dysphoric dreams that do not awaken the dreamer, or with more normative dreams. Based on recent research in cognitive neuroscience, sleep physiology, fear conditioning, and emotional-memory regulation, we propose a multilevel neurocognitive model that unites waking and sleeping as a conceptual framework for understanding a wide spectrum of disturbed dreaming. We propose that normal dreaming serves a fear-extinction function and that nightmares reflect failures in emotion regulation. We further suggest that nightmares occur as a result of two processes that we term affect load—a consequence of daily variations in emotional pressures—and affect distress—a disposition to experience events with high levels of negative emotional reactivity.

Nightmare frequency as a function of age, gender, and September 11, 2001: Findings from an Internet questionnaire.

Summary of vital statistics 2002. The City of New York. New York: Bureauof Vital Statistics, New York City Department of Health and Mental Hygiene.Sciancalepore, R., & Motta, R. W. (2004). Gender related correlates of posttraumatic stress symptomsin a World Trade Center tragedy sample. International Journal of Emergency Mental Health, 6, 15–24.Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., & Gil-Rivas, V. (2002). Nationwidelongitudinal study of psychological responses to September 11. Journal of the American MedicalAssociation, 288, 1235–1244.Simonds, J. F., & Parraga, H. (1982). Prevalence of sleep disorders and sleep behaviors in children andadolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 21, 383–388.Smedje, H., Broman, J. E., & Hetta, J. (1999). Parents’ reports of disturbed sleep in 5–7-year-oldSwedish children. Acta Paediatrica, 88, 858–865.Tanskanen, A., Tuomilehto, J., Viinamaki, H., Vartiainen, E., Lehtonen, J., & Puska, P. (2001).Nightmares as predictors of suicide.

Definitions of Dream: A Paradigm for Comparing Field Descriptive Specific Studies of Dream

A single definition for dreaming is most likely impossible given the wide spectrum of fields engaged in the study of dreaming, and the diversity in currently applied definitions. Many studies do not specify a definition, yet results are likely to be comparable only when comparable definitions of the topic are used. The alternative is to develop a classification system organizing the multiplicity of definitions for dream. A dream should not be exclusively defined as a non-conscious electrophysiologic state. Dreaming is, at least in part, a mental experience that can be described during waking consciousness. Definitions for dreaming should be utilized in research and discussion which address the various axes which define dreaming: Wake/sleep, Recall, and Content.

Relationship of Purported Measures of Pathological and Nonpathological Dissociation to Self-Reported Psychological Distress and Fantasy Immersion.

In order to investigate both the psychometric structure of the Dissociative Experiences Survey (DES) and the discriminant validity of the DES-Taxon (Waller, Putnam, & Carlson, 1996) as a specific marker of pathological dissociation, 376 non-clinical community based respondents completed the DES and a battery of psychopathology and imaginative involvement self-report measures. The DES was scored for both the Taxon and the DES-Absorption subscale. A DES subscale purported to tap normative dissociative processes. The two DES subscales demonstrated substantial overlap, both with each other (r=.80) and with the self-report measures with both DES scales comparably associated with high levels of psychological distress. Both DES subscales were also associated with elevated levels of “normative” imaginative involvement (fantasy proneness, absorption, daydreaming immersion). We conclude that both DES scales are largely indistinguishable from each other in relation to other self-report measures of psychopathology and fantasy access.

Phenomenal Qualities of Nightmare Experience in a Prospective Study of College Students

The present study investigated the relationship between both state and global measures of phenomenal qualities of nightmare experience and nightmare prevalence as measured prospectively by dream logs. Sixty three frequent nightmare individuals and 53 controls completed a retrospective measure of their sleep and dreaming processes and kept a dreaming and nightmare log for 21 consecutive nights. Nightmare prevalence was unrelated to all three state-based rating dimensions including a concurrent rating of how distressing the actual nightmare was but was significantly associated with a global measure of nightmare distress. Similarly, global ratings of dream and nightmare saliency showed greater predictive validity than ratings of the same dimensions rated concurrently. The results suggest that whether a person reports having a nightmare on any given night is more associated with how they view their global dreaming processes than with the phenomenal qualities of the actual nightmare itself.

The Relation of Fantasy Proneness, Psychological Absorption, and Imaginative Involvement to Nightmare Prevalence and Nightmare Distress

The present study prospectively investigated the relationship between nightmare prevalence, nightmare distress, and waking imaginative involvement. One hundred and sixteen individuals completed self-report indices of fantasy proneness, psychological absorption, and daydreaming as well as a sleep and dreaming questionnaire and a nightmare distress measure. Participants then kept a dreaming and nightmare log for 21 consecutive nights. As predicted, both nightmare prevalence and nightmare distress were associated with higher levels of fantasy proneness, psychological absorption, and a guilty-dysphoric daydreaming style but not with positively-toned daydreams or a highly distractible daydreaming style. Further, these results were not due to higher levels of overall dream recall. Last, these effects were additive as high scores on either fantasy proneness or absorption added significantly higher incremental validity to the prediction of nightmare prevalence and distress than just from the dysphoric daydreaming measure alone. The results are discussed within the context of emerging etiological theories of nightmare production.

Cognitive Style and Perception: The Relationship of Boundary Thinness to Visual-Spatial Processing in Dreaming and Waking Thought

The present study investigated empirically whether individuals with thin boundaries as determined by high scores on the Hartmann Boundary Questionnaire (HBQ) [1] demonstrated heightened access to imagistic stimuli than thick boundary individuals. Two independent samples, visual art students and Wall Street brokers, were administered the Rorschach, a sleep and dreaming questionnaire, and a subliminal perception task which involved the presentation of both a subliminal and supraliminal stimulus. As expected, the majority of the visual artists scored thin boundaried and the majority of Wall Street brokers scored thick boundaried on the HBQ. Boundary thinness on the HBQ was positively correlated with Rorschach boundary disruption, higher dream recall, greater reported dream salience, and increased access to subliminal activation. These data are consistent with previous data [2] and support the contention that boundaries are a useful variable in conceptualizing how individuals process imagistically-based emotionally-toned information.

The Relation of Waking Fantasy to Dreaming

This study investigated the relationship between fantasy immersion (fantasy proneness, absorption, and positive-constructive daydreaming) and qualities of nocturnal dreaming in a large non-clinical community-based sample (n = 288). The results indicate a strong linear relationship between all of the waking fantasy measures, especially positive-constructive daydreaming style, and phenomenal qualities of dreaming. Further, men and women differed significantly, both in how they experience waking fantasy and with regard to which waking fantasy measures predicted to the dreaming measures. These data suggest that waking and dreaming are not discrete states of consciousness with clearly defined parameters but rather represent continuous attentional states which comprise the “stream of consciousness” endemic to human cognition.