Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-29T03:51:44.076Z Has data issue: false hasContentIssue false
  • English
  • Français

In the midnight hour: Cancer and nightmares. A review of theories and interventions in psycho-oncology

Published online by Cambridge University Press:  04 May 2011

David K. Wellisch  and
Marie Cohen
David K. Wellisch*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
Marie Cohen
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
*
Address correspondence and reprint requests to: David K. Wellisch, 760 Westwood Plaza, C8-849, Los Angeles, CA 90095. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

The purposes of this study were: (1) to explore cancer patients' complaints of poor sleep, which often involve a combination of somatic symptoms and nightmares; and (2) to understand these sleep disturbances in the light of modern dream theories and intervention modalities.

Method:

 The literature search originated with several major articles (Revonsuo, 2000; Krakow & Zadra, 2006; Hobson, 2009) which then opened up the search through their references.  We also used the database PubMed, and employed the following key words:  cancer, nightmares/dreams, sleep disturbances, and dream theory. The literature search covered the interval between 1900 (Freud, 1900) and 2009. Our criteria for selecting studies included the most recent major review articles on the neuroscience of sleep and dreams; articles reviewing sleep disturbances in cancer patients and relevant treatments; and articles reviewing interventions for traumatic dreams.  Approximately 30 articles were deemed worthy of inclusion.

Results:

Thirty article/books/chapters met the criteria for relevance related to key theories and clinical interventions related to nightmares and traumatic dreams of cancer patients. Key concepts involve threat simulation theory and imagery rehearsal therapy in regard to theoretical and interventional paradigms significantly generalizable to cancer patients. The dream material included in this article presents patients' attempts to deal with complex threats such as intense dependency/ loss of self-sufficiency, disfigurement, and death. This is especially true with regard to the doctor–patient relationship at all stages of the illness and disease. Imagery rehearsal can facilitate empowerment in light of highly threatening and conflictual cancer-related dreams in which the patient feels helpless and victimized.

Significance of results:

This review offers a new lens on current dream theories and understanding of sleep disturbance in cancer patients as well as their familes and medical caregivers. Modern theories lead to opportunities for intervention that can both relieve symptoms and improve communication between medical caregivers and patients and families.

Keywords

CancerNightmaresThreat assessmentImage rehearsal therapy (IRT)
Type
Review Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 2 , June 2011 , pp. 191 - 200
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aserinsky, E. & Kleitman, N. (1953). Regularly occurring periods of ocular motility and concomitant phenomena during sleep. Science, 118, 361–375.CrossRefGoogle ScholarPubMed
Baylor, G.W. & Cavallero, C. (2001). Memory sources associated with REM and NREM dream reports throughout the night: A new look at the data. Sleep, 24, 165–170.Google Scholar
Bixler, E.O., Kales, A., Soldatos, C.R., et al. (1979). Prevalence of sleep disorders in the Los Angeles metropolitan area. American Journal of Psychiatry, 136, 1257–1262.Google ScholarPubMed
Davidson, J.R., MacLean, A.W., Brundage, M.D., et al. (2002). Sleep disturbance in cancer patients. Social Science and Medicine, 54, 1309–1321.CrossRefGoogle ScholarPubMed
Domhoff, G.W. (2003). The Scientific Study of Dreams: Several Networks, Cognitive Development, and Content Analysis. Washington, DC: The American Psychological Association.CrossRefGoogle Scholar
Engstrom, C.A., Strohl, R.A., Rose, L., et al. (1999). Sleep alterations in cancer patients. Cancer Nursing, 22, 143–148.CrossRefGoogle ScholarPubMed
Freud, S. (1900). The Interpretation of Dreams. New York: Random House.Google Scholar
Germain, A. & Nielsen, T. (2003). Impact of imagery rehearsal treatment on distressing dreams, psychological distress and sleep parameters in nightmare patients. Behavioral Sleep Medicine, 1, 140–154.CrossRefGoogle ScholarPubMed
Hall, C.S. & Van de Castle, R.L. (1966). The Content Analysis of Dreams. New York: Appleton-Century-Crofts.Google Scholar
Hartmann, E. (2000). We do not dream of the 3 R's: Implications for the nature of dreaming mentation. Dreaming, 10, 103–110.CrossRefGoogle ScholarPubMed
Hobson, J.A. (2009). REM sleep and dreaming: Towards a theory of protoconsciousness. Neuroscience, 10, 803–813.Google ScholarPubMed
Hobson, J.S. & McCarley, R.W. (1977). The brain as a dream state generator: An activation-synthesis hypothesis of the dream process. American Journal of Psychiatry, 134, 1335–1348.Google ScholarPubMed
Hublin, C., Kaprio, J., Partinen, M., et al. (1999) Nightmares: Familial aggregation and association with psychiatric disorders in a nationwide twin cohort. American Journal of Medical Genetics, 88, 329–336.3.0.CO;2-E>CrossRefGoogle Scholar
Jouvet, M. (1962). Reseach on the neural structures and responsible mechanisms in different phases of physiological sleep. Archives of Italian Biology, 100, 125–206.Google Scholar
Kilpatrick, D.G., Resnick, H.S., Freedy, J.R., et al. (1998). Post-traumatic stress disorder field trial: Evaluation of the PTSD Construct? Criteria A through E. In DSM-IV Sourcebook, Vol. 4, Widiger, T.A., Frances, A.J., Pincus, H.A., et al. (eds), pp. 803–846. Washington, DC: American Psychiatric Association Press.Google Scholar
Krakow, B., Germain, A., Warner, T.D., et al. (2001). The relationship of sleep quality and post traumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. Journal of Traumatic Stress, 14, 647–665.CrossRefGoogle ScholarPubMed
Krakow, B. & Neidhardt, E.J. (1992). Conquering Bad Dreams and Nightmares: A Guide to Understanding, Interpretation, and Cure. New York: Berkley.Google Scholar
Krakow, B., Tandberg, D., Scriggins, L., et al. (1995). A controlled comparison of self-rated sleep complaints in acute and chronic nightmare sufferers. Journal of Nervous & Mental Disease, 183, 623–627.CrossRefGoogle ScholarPubMed
Krakow, B. & Zadra, A. (2006). Clinical management of chronic nightmares: Imagery rehearsal therapy. Behavioral Sleep Medicine, 4, 45–70.CrossRefGoogle ScholarPubMed
Kvale, E.A. & Shuster, J.S. (2006). Sleep disturbance in supportive care of cancer: A review. Journal of Palliative Medicine, 9, 437–450.CrossRefGoogle ScholarPubMed
Menzies, V. & Gill Taylor, A. (2004). The idea of imagination: An analysis of “imagery.” Advances in Mind Body Medicine, 20, 4–10.Google ScholarPubMed
Mercadante, S., Girelli, D. & Casuccio, A. (2004). Sleep disorders in advanced cancer patients: Prevalence and factors associated. Support Care Cancer, 12, 355–359.CrossRefGoogle ScholarPubMed
Nelson, J. & Harvey, A.G. (2003a). An exploration of pre-sleep cognitive activity in insomnia: Imagery and verbal thought. British Journal of Clinical Psychology, 42, 271–288.CrossRefGoogle ScholarPubMed
Nelson, J. & Harvey, A.G. (2003b). Pre-sleep imagery under the microscope: A comparison of patients with insomnia and good sleepers. Behaviour Research &Therapy, 41, 273–284.CrossRefGoogle ScholarPubMed
Nielsen, T. & Levin, R. (2007). Nightmares: a new neurocognitive model. Sleep Medicine Review, 11, 295–310.CrossRefGoogle ScholarPubMed
Revonsuo, A. (2000). The reinterpretation of dreams: An evolutionary hypothesis of the function of dreaming. Behavioral and Brain Sciences, 23, 793–1121.CrossRefGoogle ScholarPubMed
Schredl, M. (2003) Continuity between waking activities and dream activities. Consciousness and Cognition, 12, 298–308.CrossRefGoogle ScholarPubMed
Valli, K., Revonsuo, A., Paikas, O., et al. (2005). The threat simulation theory of the evolutionary function of dreaming: Evidence from dreams of traumatized children. Consciousness and Cognition, 14, 188–218.CrossRefGoogle ScholarPubMed
Wittmann, L., Schredl, M. & Kramer, M. (2007) Dreaming in posttraumatic stress disorder: A critical review of phenomenology, psychophysiology, and treatment. Psychotherapy and Psychosomatics, 76, 25–39.CrossRefGoogle ScholarPubMed