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J Sleep Res. 2019 Jan 29:e12820. doi: 10.1111/jsr.12820. [Epub ahead of print]

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

Author information

1
Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
2
Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France.
3
Department of Psychology, Swansea University, Swansea, UK.
4
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
5
Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany.
6
Institut für Bewusstseins- und Traumforschung, Vienna, Austria.
7
Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland.
8
Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA.
9
Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany.
10
Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
11
Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
12
Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
13
Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany.
14
Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
15
Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany.
16
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany.
17
Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
18
Max Planck Institute of Psychiatry, Munich, Germany.
19
Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands.
20
International Psychoanalytic University Berlin, Berlin, Germany.

Abstract

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

KEYWORDS:

PTSD; anxiety; evidence-based medicine; exposure; imagery (psychotherapy); nightmare scripts; parasomnias; posttraumatic stress disorders; sleep-disorders

PMID:
30697860
DOI:
10.1111/jsr.12820

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