Psych Literature Review
LUCID DREAMS 1
Lynh Vu
University of Houston
PSYC 2301: Introduction to Methods in Psychology
Instructor: Dr. Tamber-Rosenau
Paper due May 4, 2019
Abstract
When a person is lucid dreaming (LD), they are consciously aware of their surroundings within the dream, and at times are able to control the contents and possibly awaken. The practice of LD is intended to manage one’s emotions and control of content during a nightmare and to reduce the frequency of nightmares. This study aims to manipulate the likelihood of LD as a method to reduce nightmares and their consequences. That is, LD may promote the reduction of recurring nightmares if exercised correctly, especially if coupled with the addition of altering one's surroundings before bedtime. Two hundred participants with self-reported frequent nightmares were recruited. This experimental study compared sleep before and after manipulation of sleep environmental factors for all participants, and before and after introduction of the use of LD to half of the participants. Nightmare frequency (NMF), quality of sleep, and distress levels were measured several times throughout the 3-month study using questionnaires and self-reports. Results were expected to show a small decrease in NMF and distress levels in the group with only changed environmental factors, and a larger decrease in NMF and distress levels in the group receiving both treatments (LD and environmental manipulations), with an increase in sleep quality in both groups. If the hypothesis is accepted, the LD as an addition to manipulation of environmental factors is supported as a method to relieve nightmare suffering. Alternatively, both treatments could have no effect on the dependent variables, suggesting that other treatments for nightmares should be pursued.
Lucid Dreaming and Nightmares
Traumatic events leading to post-traumatic stress disorder (PTSD) can affect the quality of a person’s life, including behavioral changes, psychological fear and mental disorders, mood and emotion decrease, or lack of sleep quality. Unfortunately, a full and permanent cure for PTSD remains elusive. However, many types of therapy aim to lessen the symptoms as much as possible. One such commonly experienced symptom is frequent nightmares (American Psychiatric Association, 2000). Improving one’s sleep may bring benefits to quality of life, such as reducing stress and increasing productivity, memory, and alertness. These help to counter the negative effects of PTSD. One tested way to alleviate nightmares is lucid dreaming (LD), where “one is aware that one is dreaming during the dream. Thus, it is possible to wake up deliberately, or to influence the action of the dream actively, or to observe the course of the dream passively” (Stumbrys & Erlacher, 2017, p. 42). By integrating LD practice into nightmares, the idea is to warp the nightmare, so the dream becomes less intimidating. Past research has coupled other therapies to LD and measured the effects of nightmare factors, such as nightmare frequency (NMF).
Possibly the most universal cognitive behavioral therapy relating to LD is imagery rehearsal therapy (IR). Harb et al. (2016) hypothesized that IR would intensify the awareness of LD and content memorization, bringing a decrease in nightmare symptoms. Thirty-three participants were randomly assigned among two experimental treatments: components of Cognitive-Behavioral Therapy for Insomnia (cCBT-I) and IR with cCBT-I. The purpose was to measure (1) awareness, (2) dream content control, and (3) purposeful waking. Questionnaires about each component were given to participants after treatment sessions. Only dream content control was differently impacted by the two treatment protocols; this measure correlated to a decrease in nightmares, distress, and general sleep disturbance. This may be because participants achieved a level of mastery with dream scripts from IR therapy. The researchers explained that overall, there was no statistically significant difference between the two treatment groups in terms of changes in LD constructs. Limitations of this study include the small sample size from veterans that displayed a high level of PTSD and recurring nightmares. Moreover, the data do not support the assumption that changes in dream content correlate with lucid awareness. Improved analysis and measurement of LD could have been done; for example, the Lucid Dreaming subscale of the Iowa Sleep Experiences Survey (Watson, 2001) may be a suboptimal measure of nightmare count. However, Harb et al.’s study was able to distinguish among constructs of LD and compare general cCBT-I therapy to additional IR therapy.
Gestalt therapy, similar to IR, was investigated by Holzinger et al. (2015) in order to understand whether LD adds benefit over Gestalt therapy alone. Gestalt therapy targets specific dream images with role play to desensitize fear. Researchers gathered 32 participants with frequent nightmares and randomly assigned them into two groups: Gestalt only treatment and Gestalt with LD, both for a nine-week period. The Pittsburgh Sleep Quality Index (Buysse et al., 1989), nightmare frequency (Holzinger et al., 2015), and Self-Assessment Scale on Sleep and Awakening Quality (Saletu et al., 1987) were used as measurements in questionnaire form. In the LD group, most participants successfully achieved LD. Dream frequency increased in both groups while NMF decreased, independently from each other. Compared to the Gestalt group, LD may have little to no added effect on decreased NMF, possibly making Gestalt therapy more effective. However, LD was able to modulate Gestalt therapy in that it provided faster results in dream frequency and dream recall. The extra hour difference in the amount of therapy in the LD group compared to the Gestalt group could unintentionally bring confounding variables, such as a higher level of motivation and more practice with their nightmares, potentially increasing the rate of change in some measures. A higher number of participants may clarify the effects of LD in nightmares. More efficient debriefing during treatments may improve participants’ involvement and the accuracy of the measures. This study supports LD as an add-on method to increase the efficiency of existing therapies, like Gestalt therapy.
Other types of LD-related constructs were introduced by Spoormaker et al. (2003). They hypothesized that LD would reduce trait anxiety and increase the quality of sleep. Eight participants were measured with self-rating scales on NMF and sleep quality by using the Dutch version of Spielberger State and Trait Anxiety Inventory questionnaire (van der Ploeg, 2000). Exercises to change their nightmares and to become aware of their situation were done at home, and a follow-up came two months later. Results show NMF decreased due to a change of dream content, making nightmares less frightening. Sleep improvement was also a result of not having as many nightmares. Yet, there was no effects on anxiety levels; the researchers concluded that this was because LD is too specific to decrease this construct. The sample size in this study was very small, and thus, effects may be harder to detect. The researchers simply experimented with direct LD without any other types of treatment on the effect on nightmares and, unlike other studies, the additional constructs of anxiety and sleep quality were tested.
Stumbrys & Erlacher (2017) differed from other studies by separately assessing distinct categories of LD with friendly, neutral, or threatening content. Questionnaires were given to 528 participants about their LD frequency and NMF. Participants were then asked to estimate the proportions of their LD among these categories, and how they responded to threatening characters. Results showed half of the lucid dreams were friendly, one-third were neutral, and one-fifth were threatening. As for their reactions, most dreamers fought back, some found other solutions and fewer admitted defeat. More specifically, frequent lucid dreamers gave constructive behavior, and frequent nightmare dreamers avoided the problem. As in Tholey’s study in 1988, Stumbrys & Erlacher hypothesized that lucid dreamers have fewer encounters with nightmares because they have more experience with LD and can confront threatening roles, while nightmare sufferers continuously experience a cycle because they are more likely to have a flight response than a fight response. This study was conducted solely in Germany, limiting the population to one place, and may not generalize to other cultures. Since an experiment was not conducted, data is based on participants’ past memories and it is possible that those memories could be biased towards threatening dreams. Participant bias and the online questionnaire method could thus skew the results. By recording responses in lucid dreamers and nightmare sufferers, patterns of behaviors can be distinguished between the groups, informing the understanding of how LD plays a role in nightmares.
The reviewed studies show that LD is an effective way to reduce aspects of nightmares, especially when paired with other forms of therapy. While control/awareness of dreams, sleep quality, dream recall frequency, and others increased, NMF decreased. Different therapies and exercises to promote LD were tested, which all related to cognitive behaviors. Critically, no study investigated the role of participants’ physical environments in the effectiveness of LD. A person’s surroundings may greatly affect their mental state, particularly right before going to bed. Various amounts of lighting, sounds, smell, and feel could contribute to enhancing sleep; thus, when paired with LD exercises, nightmares may be suppressed. Therefore, it is hypothesized that adjusting the sleep sensory environment, paired with therapy to promote LD, may reduce the number of nightmares. The present study will measure the effects of modified sleep environment and LD on nightmare frequency, nightmare distress, lucid dreaming frequency, and sleep quality.
Two hundred nightmare-suffering participants were recruited in the Houston area by placing advertisements in public areas and social media. Participants ranged from ages 18 to 60, with the mean age of 25.0 years. The gender distribution was 71% women and 29% men. To be included in the study, participants must have reported having at least one month in the preceding year with recurring nightmares, i.e., twice or more per month. The mean number of months with scuh recurring nightmares was 6.2. There was with no requirement for previous experience with LD. Participants were compensated monetarily for their participation ($50). All participants gave informed consent to participate in the study according to a protocol approved by the University of Houston Institutional Review Board.
The study was a between-subjects experimental, longitudinal design lasting three months. The independent variables consisted of bedroom conditions and the administration of LD therapy. Dependent variables include nightmare frequency, quality of sleep, and levels of anxiety. Nightmare frequency was operationally defined as the amount of “anxiety provoking dreams” (Spoormaker et al., 2003, p. 182) and was measured with the Nightmare Frequency Questionnaire (Krakow et al., 2000) along with anxiety in the Nightmare Distress Questionnaire (Belicki, 1992). Quality of sleep was measured by the Pittsburgh Sleep Quality Index (Buysse et al., 1989). LD frequency was measured by the Lucid Dream Frequency Self-Report.
Participants (N = 200) were recruited from advertisements and randomly assigned to two groups: one group adjusting only bedroom factors, and one group adjusting bedroom factors coupled with LD practice. Each group included 100 participants. In an initial session, informed consent was obtained either electronically or in person. Participants were familiarized with the manipulations and the importance of completing questionnaire measures accurately. To obtain baseline measures of each dependent variable, each participant completed the Nightmare Frequency Questionnaire (Krakow et al., 2000), Nightmare Distress Questionnaire (Belicki, 1992), Lucid Dream Frequency Self-Report, and the Pittsburgh Sleep Quality Index (Buysse et al., 1989).
Each participant was required to change their bedroom environment based on the following criteria: (1) no exposure to light before/while sleeping (e.g., use of sleep mask or blackout curtains), (2) reduction in outside noises (if possible), (3) lavender oil used in an aromatherapy diffuser, and (4) the use of silk sheets/pillow covers. To ensure consistency, necessary items (linens, aromatherapy supplies) were provided to each participant. These environmental manipulations were selected as favorable conditions to induce sleep and relaxation, and favoring the possibility of LD.
For the LD treatment group, LD practice was given in 90-minute sessions with a professional therapist twice a week using the protocol of Holzinger et al. (2015). Briefly, the sessions included a variety of exercises to promote LD: (1) defining LD and its purpose; (2) education about the physiology of dreams, nightmares, and sleep, including altering attitudes towards such concepts; (3) understanding dream content to promote lucidity; (4) actively using a dream journal; (5) listening to relaxing exercises geared towards LD; (6) creating alternative happy endings for nightmares; (7) discussing progress in a group setting; and (8) additional learning techniques such as concentration, relaxation, mediation, and hypnosis (Holzinger et al, 2015, p. 368).
Measures were taken each month and at the end of the three-month period, using the same measures as taken during the baseline session. The questionnaires and self-reports were completed electronically. All participants were invited for a debriefing to explain that the purpose of the study was to investigate the roles of manipulation of the sleeping environment, and manipulation of the sleeping environment coupled with lucid dreaming, to measure the effects of nightmare frequency, sleep quality, and distress. Contact information was given for any further questions. Participants were thanked for their participation and compensation was paid.
Nightmare Frequency Questionnaire. The Nightmare Frequency questionnaire (Krakow et al., 2000) assesses nightmare frequency by recording two measures: how many nights in the preceding week one or more nightmares occurred, and how many nightmares there were in total during that period.
Nightmare Distress Questionnaire. The Nightmare Distress Questionnaire (Belicki, 1992) assesses how much distress is experienced while having a nightmare. The questionnaire includes 13 questions based on a 5-point Likert scale.
Lucid Dream Frequency Self-Report. The Lucid Dream Frequency Self-Report asks participants to rate the frequency with which they engage in LD based on an 8-point scale (0 = never to 7 = several times a week).
Pittsburgh Sleep Quality Index. The Pittsburgh Sleep Quality Index (Buysse, 1989) asks participants to fill out a report relating to their sleep habits from the past month. The test instrument contains 19 items, each using a 3-point scale (0 = very good to 3 = very bad).
It was hypothesized that all participants would have an overall decrease in NMF, thus decreasing distress levels and improving sleep quality. It was further predicted that participants who practiced LD would experience larger effects than those who experienced sleep environment changes alone. Since participants in the LD treatment were able to directly face their nightmares and actively work on how to overcome them, NMF and similar measures were expected to decrease at dramatically faster rates than for participants in the environmental modification group. LD frequency was also expected to increase over time in the LD treatment group. Participants with only changed bedroom environmental conditions were expected to experience a lesser amount of NMF reduction.
The effect of LD in decreasing nightmares is supported by many previous studies, some of them including other factors or therapies to compare with LD. These results are to be expected since LD directly tampers with the experience of and coping with nightmares. Interestingly, LD actually reduced sleep quality in a past study (Holzinger & Saletus, 2015), presumably because of frustration, but a change of the sleeping environment should be able to counter such effects. Moreover, Spoormaker et al. (2003) studied distress levels and state and trait anxiety after an LD treatment and reported no significant changes in these measures. They concluded that the lack of an effect stemmed from the narrow scope of LD, which does not specifically target these variables. The coupling of environmental factors with LD may be able to produce different results.
If the hypothesis is supported, then the bedroom environment plays some role in decreasing nightmare frequency and distress, with the incremental addition of LD leading to yet greater effects. Since there is no definitive cure for nightmares, these findings can be applied to those suffering from frequent nightmares and give insight to researchers investigating similar techniques. Bedroom factors are easy to manipulate and may be preferred as a suitable method to relieve nightmare symptoms in comparison to using more extreme treatments, such as medication. LD can also be practiced by oneself without a therapist. A decrease in nightmare distress and well as improved sleep quality will follow when the threat of nightmares is diminished, yielding the benefits of a satisfactory sleep such as a boost to one's day to day quality of life.
If the hypothesis is not supported, then changing the bedroom environment and/or LD has no significant effect on the number of nightmares and their impact on distress and sleep. This would support the notion that physical conditions before sleep and the practice of LD are not useful therapies for people suffering from nightmares. Altering various sensory elements of the sleep environment could satisfy personal preference yet have no association with nightmares. Because LD therapy relates closely to imagery rehearsal therapy, these results might also suggest that image rehearsal therapy is unlikely to be effective. Similarly, other therapies that are similar to LD need to be researched further to be able to discover if any of them are effective in nightmare reduction.
A limitation of this study may include the sample of participants. Since participants were recruited voluntarily, there was no control over the gender distribution. The study included a larger set of females than males, which may confound the results. Some external validity could be present due to the sampling being distributed across the city instead of a specific suburb or institution, but the voluntary nature of participation could still limit external validity, particularly to clinical populations who are prone to high NMF (e.g., PTSD). In the experimental design, a pretest/baseline was measured before treatments, so a control group was concluded to not be necessary. However, having an extra treatment-as-usual control group may have helped to clarify the effects. Regarding the sleep environmental manipulations, there was no effort to customize the manipulations to individual comfort preferences; such customization could lead to improved results. Furthermore, the introduction of LD is meant to give participants greater control of their dream content and to lead to awareness. These components are meant to invoke positive emotions in the dreamer, but lucid nightmares are a possible occurrence and leave participants more vulnerable to threatening experiences, as reported by Stumbrys (2018). Thus, LD might not have been as effective in treating nightmares as expected, for some participants.
Some other factors to be investigated in future studies include differences in the effectiveness of sleep environment and LD manipulations as functions of gender and age. In addition, environmental conditions by themselves should be investigated in more detail, such as which combinations of environmental manipulations would best support relaxation before bedtime. Additional variables (e.g., diet, exercise) that promote the wellbeing of a person should also be studied for their potential ability to decrease negative, threatening views associated with nightmares. Alternatively, if the hypothesis is rejected, investigation of why physical factors and LD do not regulate nightmares should be conducted, including further questioning of what factors induce nightmares.
Suffering from nightmares is common to people of all ages, and is especially common among those suffering from disorders like PTSD. To reduce the ongoing problem of continuous nightmares, adjusting bedroom conditions before sleep and the practice of LD were manipulated. Results were expected to support the hypothesis that these manipulations would reduce NMF, in turn leading to decreased distress and increased quality and comfort of sleep. LD could strengthen the effects of environmental factors if incorporated into therapies for nightmares. The importance of one’s physical and mental comfort is emphasized to help the treatment of traumatic sentiments towards nightmares. The sample size and population could be expanded, and the possibility of developing lucid nightmares must be considered further. Future studies could modify these components to increase external validity, and test additional variables to find a relationship between what causes nightmares and which factors diminish them.
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